Overview
Celiac plexus syndrome, often associated with celiac axis compression syndrome, involves compression of the celiac trunk leading to symptoms such as upper abdominal pain, weight loss, and potential pancreatic dysfunction. Surgical intervention is sometimes considered for refractory cases.Diagnosis
Key Symptoms: Epigastric postprandial pain, upper abdominal pain (constant or intermittent) 12
Diagnostic Clues: Epigastric bruit, weight loss 12
Recommended Tests: Angiography confirming celiac axis compression 123
Grading: High-grade stenosis on angiography; however, collateral circulation may mask symptoms 3Management
First-line Treatment: Conservative management (pain control, dietary adjustments) 123
Surgical Intervention: Considered for patients with persistent symptoms, angiographic evidence, and specific clinical criteria (epigastric pain, weight loss, bruit) 12
Specific Procedures: Arterial reconstruction or abdominal exploration with selective vagotomy 3
Outcome Variability: Surgical outcomes vary; some patients show temporary relief, others no significant improvement 23Special Populations
Comorbidities: Previous abdominal surgeries (appendectomy, cholecystectomy, vagotomy, pyloroplasty) may not preclude surgical intervention but often lack symptom relief 2Key Recommendations
Select surgical candidates carefully based on persistent epigastric pain, weight loss, angiographic evidence of celiac axis compression, and presence of an epigastric bruit (Evidence: Moderate) 1
Consider conservative management initially, reserving surgery for refractory cases with clear diagnostic criteria (Evidence: Moderate) 123
Evaluate collateral circulation via angiography to assess the clinical significance of celiac axis compression (Evidence: Weak) 3References
1 Daskalakis MK. Celiac axis compression syndrome. International surgery 1982. link
2 Watson WC, Sadikali F. Celiac axis compression: experience with 20 patients and a critical appraisal of the syndrome. Annals of internal medicine 1977. link
3 Mihas AA, Laws HL, Jander HP. Surgical treatment of the celiac axis compression syndrome. American journal of surgery 1977. link90154-4)