Loffeld R J, Overtoom H A, Rauwerda J A
Department of Internal Medicine, Ziekenhuis De Heel, Zaandam, The Netherlands.
Digestion. 1995;56(6):534-7. doi: 10.1159/000201288.
An ongoing debate in the literature discusses whether compression of the celiac axis (CA) and/or the superior mesenteric artery (SMA) by the arcuate ligament of the diaphragm may be responsible for a clinical syndrome. Five patients with postprandial epigastric pain and weight loss, with a loud systolic bruit in the epigastric region are described. In 4 cases, no other obvious explanation for the complaints was present except compression of the CA and SMA by the arcuate ligament of the diaphragm as shown on angiography. One patient had cholecystolithiasis. Two patients suffered from thrombosis in the CA with major stenosis of the SMA. In 3 cases, solitary stenosis of the CA was present. In 3 cases, important collateral circulation was seen, and 1 patient had possibly ischemic gastric ulcers indicating the ischemic nature of the complaints. Vascular reconstruction was done in 4 patients. One patient with a stenosis of less than 50% underwent cholecystectomy and was free of complaints thereafter. All other 4 patients were free of complaints after the operation. The CA compression syndrome should be considered in the differential diagnosis of patients with upper abdominal pain, weight loss and a loud systolic bruit in the epigastric region.
文献中正在进行的一场争论探讨了膈肌弓状韧带对腹腔干（CA）和/或肠系膜上动脉（SMA）的压迫是否可能导致一种临床综合征。本文描述了5例餐后上腹部疼痛和体重减轻、上腹部区域有响亮收缩期杂音的患者。在4例中，血管造影显示除膈肌弓状韧带对CA和SMA的压迫外，对这些主诉没有其他明显的解释。1例患者有胆囊结石。2例患者CA发生血栓形成，SMA有严重狭窄。3例存在CA孤立性狭窄。3例可见重要的侧支循环，1例患者可能有缺血性胃溃疡，提示这些主诉具有缺血性质。4例患者进行了血管重建。1例狭窄小于50%的患者接受了胆囊切除术，此后无主诉。其他4例患者术后均无主诉。在上腹部疼痛、体重减轻且上腹部区域有响亮收缩期杂音的患者的鉴别诊断中应考虑CA压迫综合征。
