A Tight Squeeze: Unpacking the Manifestations of Celiac Artery Compression Syndrome

Abstract Celiac Artery Compression Syndrome (CACS), or median arcuate ligament syndrome, is a rare cause of chronic abdominal pain due to compression of the celiac artery by the diaphragmatic ligament. The celiac trunk supplies blood to the stomach, liver, and spleen, and its compression may lead to ischemia. Diagnosis relies on contrast-enhanced CT (CECT), which reveals ligament thickness, vessel narrowing, and organ damage. This case series identified 7 CACS cases: Case 1: A 26-year-old male with 40% celiac trunk narrowing and post-stenotic dilatation. Case 2: A 14-year-old boy with mild narrowing and postprandial pain. Case 3: A 35-year-old male with 80% narrowing, splenic/renal infarcts. Case 4: A 35-year-old female with 90% narrowing, splenic infarcts, and Arc of Buhler. Case 5: A 37-year-old male with pancreatitis and splenic vein thrombosis. Case 6: A 50-year-old female with episodic vomiting and 60% celiac stenosis, has diffuse abdominal pain. Case 7: A 22-year-old athlete with exercise-induced pain and collateral vessel formation due to chronic compression. The median arcuate ligament’s thickness (6.2–7.8 mm) correlated with stenosis severity. Symptoms often worsened during expiration due to increased compression. Complications ranged from asymptomatic narrowing to life-threatening infarcts or pancreatitis. Conclusion: CACS manifests variably, necessitating prompt CECT for diagnosis. Early intervention can mitigate morbidity, though treatment strategies require further standardization.