Speakers - 2027

Title: Diagnosis and treatment of celiac artery compression syndrome in children

Abstract

Objective: Improving treatment outcomes for patients with celiac artery compression syndrome (CACS).

Materials and methods: From 2021 to 2024, 132 patients with CACS aged 4 to 17 years (mean age 13.5 years) were operated. Combined pathology of the upper gastrointestinal tract was diagnosed in 50 (37.8%) patients. When diagnosing CACS, the following data were evaluated: anamnesis, complaints, Doppler ultrasound, angiography, esophagogastroscopy and barium esophagram. GERD was detected in 34 patients, chronic duodenal obstruction in 2 cases and a combination of GERD with chronic duodenal obstruction in 14 patients. According to angiography (107 studies), the patients were divided into 2 groups. Group I consisted of 31 patients (28.9%) without collateral blood flow and group II consisted of 76 patients (71.1%) who had critical stenosis with collateral blood flow. After a comprehensive examination, celiac artery decompression surgery was performed. The surgical intervention consisted of laparoscopic dissection of the median arcuate ligament of the diaphragm to the level of origin of the celiac artery from the abdominal aorta. In case of combined pathology, simultaneous surgical interventions were performed.

Results: In a comparative analysis of the 2 groups according to angiography data, abdominal pain syndrome was 4 times more common in patients with celiac artery disease without compensatory circulation (p<0.05). Also, when analyzing the treatment results, pain relief was noted in more than 80% of patients after celiac artery dissection (p<0.001). When assessing changes in blood flow velocity after surgery, a decrease in the velocity in the celiac artery to normal values was noted (Me (before surgery) = 272.5 cm/sec, Me (after surgery) = 170 cm|sec, p<0.001). In 127 cases, celiac artery decompression was performed using laparoscopic access and in 5 cases, laparotomy was performed. The average duration of the laparoscopic surgery was 48.6 minutes. Conversion was performed in 2 cases due to bleeding. There were no fatal outcomes. Simultaneous surgeries for combined pathology were performed in 36 patients.

Conclusion: CACS is a rare pathology with a non-specific clinical picture, which should be considered after excluding other causes of abdominal pain. Angiography is the method of choice in diagnosing CACS and determining indications for celiac artery decompression. Pain relief in patients with CACS after surgery is achieved in more than 80% of cases. When detecting combined pathology of the upper gastrointestinal tract with CACS, their simultaneous correction is preferable.