Laparoscopic dissection in children with celiac artery compression syndrome

Abstract

BACKGROUND: A cause of abdominal pain in children may be compression stenosis of the celiac trunk (Dunbar’s syndrome). This disease occurs when the median arcuate ligament of the diaphragm compresses the celiac trunk, thereby creating compression stenosis, causing the arterial hemodynamics in the artery to suffer and provide adequate blood circulation to the abdominal cavity organs. Medical statistics indicate that 10% to 15% of children and adolescents suffering from chronic abdominal pain have compression stenosis of the celiac trunk.

AIM: This study aims to improve the diagnostic results and identify the indications for the surgical treatment of children with compression stenosis of the celiac trunk.

MATERIALS AND METHODS: From 2015 to 2020 at the N.F. Filatov Children’s Hospital, 64 patients, aged 4 to 17 years underwent surgical treatment for compression stenosis of the celiac trunk. There are 42 boys (66%) and 22 girls (34%). The leading clinical manifestation in all patients was abdominal pain. Associated surgical pathology was observed in 34 of them. The diagnosis was based on anamnesis, examination, ultrasound examination with Doppler and celiac trunk blood flow measurements, multispiral computed tomography, and angiography.

RESULTS: After completing the examination, 61 patients underwent laparoscopic decompression of the celiac trunk, and three children were operated on using the laparotomic approach. In all cases, the leading cause of compression stenosis of the celiac trunk was the median arcuate ligament of the diaphragm combined with the neurofibrous tissue of the celiac plexus. The average duration of the operation was 50 minutes. Intraoperative blood loss did not exceed 5–30 ml. One conversion completed. There were no postoperative complications in the early postoperative period. The patients were discharged in satisfactory condition. The control examination was conducted in the period from six months to three years. In 97% of patients, clinical symptoms of abdominal ischemia were not detected.

CONCLUSION: Our experience indicates the possibility of diagnosing compression stenosis of the celiac trunk in children at early disease stages and laparoscopic treatment success of patients with this disease.

Keywords

Celiac artery compression syndrome in children / Dunbar syndrome / median arcuate ligament syndrome / laparoscopic decompression of the celiac trunk

References

[1] Clinicalangiology. Ed. acad. RAMS. Pokrovsky AV. Moscow: Medicine; 2004. P. 22–24; 139–140. (In Russ.)

[2] Клиническая ангиология. Под ред. акад. РАМН. Покровского А.В. М.: Медицина, 2004. С. 22–24; 139–140.

[3] Dunbar JD, Molnar W, Beman FF, Marable SA. Compression of the celiac trunk and abdominal angina. Am J Roentgenol Radium Ther Nucl Med. 1965;95(3):731–744. DOI: 10.2214/ajr.95.3.731

[4] Dunbar J.D., Molnar W., Beman F.F., Marable S.A. Compression of the celiac trunk and abdominal angina // Am J Roentgenol Radium Ther Nucl Med. 1965. Vol. 95, No. 3. P. 731–744. DOI: 10.2214/ajr.95.3.731

[5] Belmer SV, Razumovsky AYu, Khavkin AI, et al. Intestinal diseases in children. Volume 1. M.: Medpractica-M; 2018. 436 p. (In Russ.)

[6] Бельмер С.В., Разумовский А.Ю., Хавкин А.И., и др. Болезни кишечника у детей. Том 1. М.: ИД Медпрактика-М, 2018. 436 с.

[7] Belmer SV, Volynets GV, Gurova ММ, et al. Draft clinical guidelines of the Russian Society of Paediatric Gastroenterologists, Hepatologists and Nutritionistson diagnosis and treatment of functional gastrointestinal disorders in children. Pediatric Nutritional Issues. 2019;17(6):27–48. (In Russ.) DOI: 10.20953/1727-5784-2019-6-27-48

[8] Бельмер С.В., Волынец Г.В., Гурова М.М., и др. Проект клинических рекомендаций Российского общества детских гастроэнтерологов, гепатологов и нутрициологов по диагностике и лечению функциональных расстройств органов пищеварения у детей // Вопросы детской диетологии. 2019. Т. 17, № 6. С. 27–48. DOI: 10.20953/1727-5784-2019-6-27-48

[9] Khavkin AI, Komarova ON. Functional disorders of the digestive system in children and microbiota. Practical issues of pediatrics. 2017;12(3):54–62. (In Russ.) DOI: 10.20953/1817-7646-2017-3-54-62

[10] Хавкин А.И., Комарова О.Н. Функциональные расстройства органов пищеварения у детей и микробиота // Вопросы практической педиатрии. 2017. Т. 12. № 3. С. 54–62. DOI: 10.20953/1817-7646-2017-3-54-62

[11] Privorotsky VF, Luppova NE, Belmer SV, et al. Working protocol of diagnosis and treatment of gastroesophageal reflux disease in children (1st part). Pediatric Nutrition. 2015;13(1):70–74. (In Russ.)

[12] Приворотский В.Ф., Луппова Н.Е., Бельмер С.В., и др. Рабочий протокол диагностики и лечения гастроэзофагеальной рефлюксной болезни у детей (1-я часть) // Вопросы детской диетологии. 2015. Т. 13, № 1. С. 70–74.

[13] Bech FR. Celiac artery compression syndromes. Surg Clin North Am. 1997;77(2):409–424. DOI: 10.1016/s0039-6109(05)70558-2

[14] Bech F.R. Celiac artery compression syndromes // Surg Clin North Am 1997. Vol. 77, No. 2. P. 409–424. DOI: 10.1016/s0039-6109(05)70558-2

[15] Roayaie S, Jossart G, Gitlitz D, et al. Laparoscopic release of celiac artery compression syndrome facilitated by laparoscopic ultrasound scanning to confrm restoration of fow. Journal of Vasc Surg. 2000;32(4):814–817. DOI: 10.1067/mva.2000.107574

[16] Roayaie S., Jossart G., Gitlitz D., et al. Laparoscopic release of celiac artery compression syndrome facilitated by laparoscopic ultrasound scanning to confrm restoration of fow // Journal of Vasc Surg. 2000. Vol. 32, No. 4. P. 814–817. DOI: 10.1067/mva.2000.107574

[17] Moneta GL, Yeager RA, Dalman R, et al. Durlex ultrasound criteria for diagnosis of splanchic artery stenosis or occlusion. J Vasc Surg. 1991;14(4):511–520.

[18] Moneta G.L., Yeager R.A., Dalman R., et al. Durlex ultrasound criteria for diagnosis of splanchic artery stenosis or occlusion // J Vasc Surg. 1991. V.14. P. 511–520.

[19] Ultrasound diagnostics of vascular diseases. Ed. Kulikova VP. Moscow: Strom; 2011. P. 46–47. (In Russ.)

[20] Ультразвуковая диагностика сосудистых заболеваний. Под ред. Куликова В.П. 2-е изд. М.: Стром, 2011. С. 46–47.

[21] Heo S, Kim HJ, Kim B, et al. Clinical impact of collateral circulation in patients with median arcuate ligament syndrome. Diagn Interv Radiol. 2018;24(4):181–186. DOI: 10.5152/dir.2018.17514

[22] Heo S., Kim H.J., Kim B., et al. Clinical impact of collateral circulation in patients with median arcuate ligament syndrome // Diagn Interv Radiol. 2018. Vol. 24, No. 4. P. 181–186. DOI: 10.5152/dir.2018.17514

[23] Sgroi MD, Kabutey N-K, Krishnam M, Fujitani RM. Pancreaticoduodenal artery aneurysms secondary to median arcuate ligament syndrome may not need celiac artery revascularization or ligament release. Ann Vasc Surg. 2015;29(1):122.e1–7. DOI: 10.1016/j.avsg.2014.05.020

[24] Sgroi M.D., Kabutey N.K., Krishnam M., Fujitani R.M. Pancreaticoduodenal artery aneurysms secondary to median arcuate ligament syndrome may not need celiac artery revascularization or ligament release // Ann Vasc Surg. 2015. Vol. 29, No. 1. P. 122.e1–7. DOI: 10.1016/j.avsg.2014.05.020

[25] Park CM, Chung JW, Kim HB, et al. Celiac axis stenosis: incidence and etiologies in asymptomatic individuals. Korean J Radiol. 2001;2(1):8–13. DOI: 10.3348/kjr.2001.2.1.8

[26] Park C.M., Chung J.W., Kim H.B., et al. Celiac axis stenosis: incidence and etiologies in asymptomatic individuals // Korean J Radiol. 2001. Vol. 2, No. 1. P. 8–13. DOI: 10.3348/kjr.2001.2.1.8

[27] Ignashov AM, Kanaev AI, Kurkov AA, et al. Compression stenosis of the celiac trunk in children and adolescents. Grekov’s Bulletin of Surgery. 2004;163(5):78–81. (In Russ.)

[28] Игнашов А.М., Канаев А.И., Курков А.А., и др. Компрессионный стеноз чревного ствола у детей и подростков // Вестник хирургии им. И.И. Грекова. 2004. Т. 163, № 5. С. 78–81.

[29] Scholbach T. Celiac artery compression syndrome in children, adolescents, and young adults: clinical and color duplex sonographic features in a series of 59 cases. J Ultrasound Med. 2006;25(3):299–305. DOI: 10.7863/jum.2006.25.3.299

[30] Scholbach T. Celiac artery compression syndrome in children, adolescents, and young adults: clinical and color duplex sonographic features in a series of 59 cases // J Ultrasound Med. 2006. Vol. 25, No. 3. P. 299–305. DOI: 10.7863 / jum.2006.25.3.299

[31] Erden A, Yurdakul M, Cumhur T. Marked increase in flow velocities during deep expiration: A duplex Doppler sign of celiac artery compression syndrome. Cardiovasc Intervent Radiol. 1999;22(4):331–332. DOI: 10.1007/s002709900399

[32] Erden A., Yurdakul M., Cumhur T. Marked increase in flow velocities during deep expiration: A duplex Doppler sign of celiac artery compression syndrome // Cardiovasc Intervent Radiol. 1999. Vol. 22, No. 4. P. 331–332. DOI: 10.1007/s002709900399

[33] Den Bo, Ignashov AM, Perley VE, et al. The significance of respiratory and orthostatic tests in duplex scanning in diagnostics of celiac artery compression syndrome. Grekov’s Bulletin of Surgery. 2013;172(2):28–31. (In Russ.)

[34] Дэн Бо, Игнашов А.М., Перлей В.Е., и др. Значение дыхательных и ортостатических проб при дуплексном сканировании в диагностике синдрома компрессии чревного ствола // Вестник хирургии им. И.И. Грекова. 2013. Т. 172, № 2. С. 28–31.

[35] AbuRahma AF, Stone PA, Srivastava M, et al. Mesenteric/celiac duplex ultrasound interpretation criteria revisited. J Vasc Surg. 2012;55(2):428–436.e6. DOI: 10.1016/j.jvs.2011.08.052

[36] AbuRahma A.F., Stone P.A., Srivastava M., et al. Mesenteric/celiac duplex ultrasound interpretation criteria revisited // J Vasc Surg. 2012. Vol. 55, No. 2. P. 428–436.e6. DOI: 10.1016/j.jvs.2011.08.052

[37] Aschenbach R, Basche S, Vogl TJ. Compression of the celiac trunk caused by median arcuate ligament in children and adolescent subjects: evaluation with contrast-enhanced MR angiography and comparison with Doppler US evaluation. J Vasc Interv Radiol. 2011;22(4):556–561. DOI: 10.1016/j.jvir.2010.11.007

[38] Aschenbach R., Basche S., Vogl T.J. Compression of the celiac trunk caused by median arcuate ligament in children and adolescent subjects: evaluation with contrast-enhanced MR angiography and comparison with Doppler US evaluation // J Vasc Interv Radiol. 2011. Vol. 22, No. 4. P. 556–561. DOI: 10.1016/j.jvir.2010.11.007

[39] Norton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 2005;25(5):1177–1182. DOI: 10.1148/rg.255055001

[40] Norton K.M., Talamini M.A., Fishman E.K. Median arcuate ligament syndrome: evaluation with CT angiography // Radiographics. 2005. Vol. 25. No. 5. P. 1177–1182. DOI: 10.1148/rg.255055001

[41] TuranIlica A, Kocaoglu M, Aslan Bilici A, et al. Median arcuate ligament syndrome: multidetector computed tomography findings. J Comput Assist Tomogr. 2007;31(5):728–731. DOI: 10.1097/rct.0b013e318032e8c9

[42] TuranIlica A., Kocaoglu M., Aslan Bilici A., et al. Median arcuate ligament syndrome: multidetector computed tomography findings // J Comput Assist Tomogr. 2007. Vol. 31, No. 5. P. 728–731. DOI: 10.1097/rct.0b013e318032e8c9

[43] Manghat NE, Mitchell G, Hay CS, Wells IP. The median arcuate ligament syndrome revisited by CT angiography and the use of ECG gating – a single centre case series and literature review. Br J Radiol. 2008;81:735–742. DOI: 10.1259/bjr/43571095

[44] Manghat N.E., Mitchell G., Hay C.S., Wells I.P. The median arcuate ligament syndrome revisited by CT angiography and the use of ECG gating — a single centre case series and literature review // Br J Radiol. 2008. Vol. 81. P. 735–742. DOI: 10.1259/bjr/43571095

[45] Aschenbach R, Basche S, Vogl TJ. Compression of the celiac trunk caused by median arcuate ligament in children and adolescent subjects: evaluation with contrast-enhanced MR angiography and comparison with Doppler US evaluation. J Vasc Interv Radiol. 2011;22(4):556–561. DOI: 10.1016/j.jvir.2010.11.007

[46] Aschenbach R., Basche S., Vogl T.J. Compression of the celiac trunk caused by median arcuate ligament in children and adolescent subjects: evaluation with contrast-enhanced MR angiography and comparison with Doppler US evaluation // J Vasc Interv Radiol. 2011. Vol. 22, No. 4. P. 556–561. DOI: 10.1016/j.jvir.2010.11.007

[47] Klimas A, Lemmer A, Bergert H, et al. Laparoscopic treatment of celiac artery compression syndrome in children and adolescents. Vasa. 2015;44(4):305–312. DOI: 10.1024/0301-1526/a000446

[48] Klimas A., Lemmer A., Bergert H., et al. Laparoscopic treatment of celiac artery compression syndrome in children and adolescents // Vasa. 2015. Vol. 44, No. 4. P. 305–312. DOI: 10.1024/0301-1526/a000446

[49] Jimenez JC, Harlander-Locke М, Dutson ЕР. Open and laparoscopic treatment of median arcuate ligament syndrome. J Vasc Surg. 2012;56:869–873. DOI: 10.1016/j.jvs.2012.04.057

[50] Jimenez J.C., Harlander-Locke М., Dutson Е.Р. Open and laparoscopic treatment of median arcuate ligament syndrome // J Vasc Surg. 2012. Vol. 56. P. 869–873. DOI: 10.1016/j.jvs.2012.04.057

[51] Tulloch AW, Jiminez JC, Lawrence PF, et al. Laparoscopic versus open celiac ganglionectomy in patients with median arcuate ligament syndrome. J Vasc Surg. 2010;52(5):1283–1289. DOI: 10.1016/j.jvs.2010.05.083

[52] Tulloch A.W., Jiminez J.C., Lawrence P.F., et al. Laparoscopic versus open celiac ganglionectomy in patients with median arcuate ligament syndrome // J Vasc Surg. 2010. Vol. 52, No. 5. P. 1283–1289. DOI: 10.1016/j.jvs.2010.05.083

[53] Schweizer P, Berger S, Schweizer M, et al. Arcuate ligament vascular compression syndrome in infants and children. J Pediatr Surg. 2005;40(10):1616–1622. DOI: 10.1016/j.jpedsurg.2005.06.040.

[54] Schweizer P., Berger S., Schweizer M., et al. Arcuate ligament vascular compression syndrome in infants and children // J Pediatr Surg. 2005. Vol. 40, No. 10. P. 1616–1622. DOI: 10.1016/j.jpedsurg.2005.06.040.

RIGHTS & PERMISSIONS

Zainulabidov R.A., Razumovsky A.Y., Mitupov Z.B., Chumakova G.Y.