Compression stenosis of the celiac trunk what are the symptoms of the cause and treatment

Timely diagnosis of any disease can save a human life. Today, modern medicine provides a huge range of activities to conduct the most detailed examination of the entire human body.

Diagnosis of the celiac trunk involves:

  • Inspection of leading experts. Initial examination involves the identification of all available external symptoms, for this it is necessary to consult a gastroenterologist. First, the doctor conducts an external examination of the patient, after which he prescribes a number of necessary tests. Based on the data obtained, a putative diagnosis is made.
  • After visual inspection, thorough palpation is performed. Thanks to which the doctor assesses the condition of the vessels and the degree of their expansion. To detect noise, it is possible to listen to the cavity.
  • Hardware inspection methods. After a detailed visual examination, the doctor may prescribe some hardware examinations if necessary. Thanks to which you can accurately determine the degree of the disease, its stage, etc. The most popular examinations of this kind include:
  • Fluoroscopy. Here they examine the area of ​​the abdominal cavity and stomach. Such examination methods provide the most detailed information about the condition of the celiac trunk. This method allows you to accurately determine the presence of this disease.
  • Computed tomography allows you to carefully examine the state of blood vessels and determine the current state of existing diseases. Thanks to this method of examination, it is possible to determine with maximum accuracy the location of the focus of the disease.
  • Doppler ultrasound allows you to accurately assess the condition of the celiac trunk, as well as the speed of blood flow through the vessels.
  • Inspection of narrow specialists. Due to the fact that the abdominal cavity is as closely as possible connected with all internal organs, especially the pelvic and genital organs. Therefore, it is necessary to undergo a detailed examination of the whole organism as a whole. In order for the doctor to be able to determine the diagnosis as precisely as possible and prescribe the most suitable course of treatment.

Ultrasound of the abdominal cavity

When making a diagnosis, it is mandatory to conduct endoscopic examinations of the stomach and colon, fluoroscopy of the stomach, esophagus and duodenum, ultrasound examinations of the pelvic organs and abdominal cavity. These studies are necessary to rule out other causes of the disease.

Computed tomography with contrasting blood vessels is also performed, the results of which allow a more accurate diagnosis to be made. Computed tomography provides a three-dimensional picture, which makes it possible to determine the degree of compression of the celiac trunk and the exact determination of the localization of the process.

The complex of studies includes duplex ultrasound scanning of vessels located in the abdominal cavity. In the process of scanning, an important test is carried out on inspiration, which confirms the participation of the diaphragm leg in stenosis and the blood flow velocity is estimated. If necessary, the examination is supplemented by direct arteriography. A thin catheter is inserted into the femoral artery, then brought to the vessel. The image of the vessel is obtained after administration of a contrast medium.

To complete the diagnostic picture, you should consult a gastroenterologist, and women should also visit a gynecologist.

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Study history

The discovery of the phenomenon of compression stenosis of the celiac trunk (KSChS) is associated with the history of the study of abdominal ischemic disease. The term “angina abdominalis” (abdominal ischemic disease) was introduced in 1903 by G. Bacelli. Initially, the genesis of the disease was associated exclusively with atherosclerosis of the vessels of the abdominal cavity. Later, studies appeared showing the importance of other pathologies that cause intravasal vasoconstriction [1].

However, in 1963, P.-T. Harjola reported a patient with symptoms of “abdominal sore throat,” the cause of which was extravasal compression of the celiac trunk with scar-modified ganglionic tissue of the celiac plexus. Then, in 1965, the American doctor JD Dunbar and co-authors, on the basis of clinical and angiographic data and the results of operations, showed that the cause of abdominal ischemia in 13 patients was compression of the celiac trunk with a median arcuate ligament of the diaphragm [1]. In English literature, this phenomenon has entered under the name “syndrome of the median arched ligament” or “Dunbar syndrome.”

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Subsequently, other authors showed that sclerosed periarterial tissue, celiac ganglia, legs of the diaphragm, phrenic arteries, enlargement of organs adjacent to the vessels (pancreas, lymph nodes), etc. can also be the cause of compression of the celiac trunk. Comparative frequency of isolated compression of the celiac trunk and the variety of causes that caused it made it possible to distinguish it as an independent syndrome [1].

clinical picture

The main complaint of patients with CSF is abdominal pain. This complaint is presented from 97 [4] to 100% [1] of the examined patients. In most cases, the pain is localized in the epigastric region (epigastrium), less often in the umbilical region, hypochondrium, iliac regions, lower abdomen or throughout the abdomen. In some patients, the pain is constant, in others it is paroxysmal.

Most often, the occurrence or intensification of pain is associated with eating, its quantity and nature. The pain occurs 15-20 minutes after eating, subsides after 1-2 hours and depends on the amount of food taken. Fear of the resumption of pain often causes patients to limit its number. Sometimes patients associate the appearance of an attack with the intake of cold, spicy, sweet food.

The second most important factor that provokes a pain attack is physical activity. This can be lifting and carrying weights, physical labor, especially in a bent position (washing clothes, mopping), long walking or running. Often, pain occurs under the combined influence of two factors: food intake and physical activity.

Dyspeptic disorders are the second complaint of patients with CSF. These include, first of all, a feeling of heaviness and bursting in the epigastric region, which worries almost all patients. Some authors consider it as the equivalent of pain. Dyspeptic symptoms also include belching, heartburn, nausea, vomiting, a feeling of bitterness in the mouth, etc.

The third complaint of patients with CSF is neurovegetative disorders. They can manifest themselves or accompany a pain attack. These include headaches, palpitations, increased sweating, shortness of breath, shortness of breath, a feeling of pulsation in the abdomen, poor tolerance of heat and cold, etc. Almost all patients report general weakness, fatigue, and decreased performance [1].

Operation

The operation of compression stenosis of the celiac trunk is necessary in almost every case, because it is simply impossible to restore normal blood supply in other ways. The tactics of surgical treatment are selected from the degree of neglect of the disease and its course. Be sure to take into account the general condition of the patient and the presence of other diseases of the internal organs. The further prognosis also depends on well-chosen treatment.

Pathogenesis

The pathophysiological mechanisms of CSF are caused by hemodynamic disturbances in the celiac trunk and associated abdominal arteries. The celiac trunk supplies blood to the stomach, duodenum, pancreas, gall bladder, liver and spleen. The branches of the celiac trunk are connected by anastomoses with the branches of the superior mesenteric artery supplying blood to the large and small intestines.

The branches of the celiac trunk, upper and lower mesenteric arteries make up a single pool supplying the digestive organs with blood. Decreased blood flow in at least one of the unpaired visceral arteries leads to a deficiency in blood supply to the entire digestive system [1]. Lack of oxygen and nutrient-rich blood flow leads to hypoxia and ischemia of the digestive system and the development of abdominal ischemic disease.

Depending on which organ suffers the most from a lack of blood supply, patients with KSCh may develop symptoms of various gastroenterological diseases. Thus, a deficiency in the blood supply to the stomach and duodenum leads to the development of gastritis, duodenitis and peptic ulcer. Deficiency of blood supply to the intestine leads to the development of ischemic colitis and enteritis.

Damage to the pancreas is manifested by symptoms of pancreatitis, liver damage – hepatitis, etc. Some patients present the whole spectrum of gastroenterological diseases that occur simultaneously and mutually aggravate each other. According to the data of L. V. Potashov and co-authors, most often KSCh is combined with ulcers of the stomach and duodenum.

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Aftermath

As a rule, the consequences of compression stenosis of the celiac trunk is a significant violation of the blood supply to all organs of the gastrointestinal tract. Perhaps the development of diseases that are directly related to oxygen starvation of tissues.

Any damage to the stomach can provoke the development of gastritis, dudenitis and ulcers. Enteritis and colitis may occur in the intestines. Any disturbance in the blood supply to the liver or pancreas is fraught with the development of pancreatitis and hepatitis. In rare cases, the manifestation of all diseases at the same time is possible.

It is safe to say that stenosis is a disease that can only be cured by surgery. The main thing is to timely determine the presence of pathology. Having discovered the first signs of the disease, it is necessary to immediately seek help from specialists and then the prognosis will be favorable.

Causes of Celiac Stenosis

The main reasons for the development of compression stenosis of the celiac trunk is the presence of a fibrous bridge, which is pressed between the legs of the diaphragm itself. As a rule, such a pathology is a congenital anomaly.

Many factors can provoke the occurrence of this very serious disease. The main one of which is a poor genetic predisposition. This pathology can be transmitted through many generations. It is worth noting that the chronic form of compression stenosis of the celiac trunk is difficult not only to treatment, but also to diagnosis. But at the same time, it does not cause the patient much discomfort.

It is worth noting that there are a number of diseases that can provoke the development of this pathology.

  • Pathological enlargement of the lymph nodes.
  • The presence of plaques and blood clots in the vessels.
  • Rapid pancreatic enlargement.
  • Uncontrolled proliferation of neurofibrotic tissue.

A significant narrowing of the lumen of the artery can be triggered by various intravascular pathologies. One of these include cholesterol plaques. Also, this condition can be triggered by extravascular compression. In some cases, the celiac trunk is squeezed by inflamed nearby organs or lymph nodes. Often the reason for this is a number of congenital anomalies.

Most often, stenosis of the celiac trunk occurs when a fibrous jumper presses it between the legs of the diaphragm. In most cases, this condition is congenital.

Etiology

According to the researchers, the formation of KSChS is associated with the structural features and development of the aortic orifice of the diaphragm. The aortic aperture of the diaphragm is formed by the tendon edges of the right and left legs of the diaphragm, connecting them with the middle arcuate ligament of the diaphragm and the vertebral bodies. Normally, in a healthy person, the median arched ligament of the diaphragm (SDDS) is located directly above the mouth of the celiac trunk.

However, in some people, SDSD is located below the mouth of the celiac trunk, which leads to compression of the vessel and, as a result, impaired blood circulation in it. In angiographic images of such patients, you can see how the celiac trunk is pressed down to the abdominal aorta, narrowed near its mouth and pathologically expanded below the site of compression.

The abnormal location of SDDS is most likely a congenital pathology, as indicated by the fact that it is often found in close relatives. In addition, in individuals suffering from CSF, other developmental abnormalities are often found. So, in the literature, it was pointed out that KSChS is often combined with asthenic physique, mitral valve prolapse of the heart [3], etc. According to L. V. Potashov et al, KSChS should be considered a congenital disease with an autosomal dominant type of inheritance [1] .

However, in addition to hereditary factors, acquired factors also play a role in the genesis of the disease. Many authors indicate that not only SDDS, but also the neurofibrotic tissue of the celiac plexus is often involved in the compression of the celiac trunk. In a number of patients with CSF, a constant progression of the disease has been observed for a number of years.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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