pirogovestnikВестник Национального медико-хирургического центра им. Н.И. ПироговаBulletin of Pirogov National Medical & Surgical Center2072-82552782-3628Национальный медико-хирургический Центр им. Н.И. Пирогова10.25881/20728255_2025_20_4_145pirogovestnik-489Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCASE REPORTSПОВТОРНОЕ ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ СИНДРОМА КОМПРЕССИИ ЧРЕВНОГО СТВОЛА У МОЛОДОГО ПАЦИЕНТАREOPERATIVE MANAGEMENT OF CELIAC TRUNK COMPRESSION SYNDROME IN A YOUNG ADULT PATIENTБатрашовВ. А.BatrashovV. A.

Москва

 Moscow 

ДжалаевФ. Ш.DzhalaevF. Sh.

Москва

Moscow

furkatjon98@bk.ruЮдаевС. С.YudaevS. S.

Москва

Moscow

СергеевО. Г.SergeevO. G.

Москва

Moscow

АдильсултановЭ. Б.AdilsultanovE. B.

Москва

Moscow

ФГБУ «Национальный медико-хирургический Центр им. Н.И. Пирогова»РоссияPirogov National Medical and Surgical CenterRussian Federation202505122025204145147Copyright © Батрашов В.А., Джалаев Ф.Ш., Юдаев С.С., Сергеев О.Г., Адильсултанов Э.Б., 20252025Батрашов В.А., Джалаев Ф.Ш., Юдаев С.С., Сергеев О.Г., Адильсултанов Э.Б.Batrashov V.A., Dzhalaev F.S., Yudaev S.S., Sergeev O.G., Adilsultanov E.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://submit.pirogov-vestnik.ru/jour/article/view/489

Синдром компрессии чревного ствола представляет собой редкую патологию, являющуюся причиной хронической постпрандиальной боли и потери массы тела, патогенетически обусловленную компрессией чревного ствола срединной дугообразной связкой. Приведено клиническое наблюдение 18-летнего пациента с рецидивирующей симптоматикой после лапароскопической декомпрессии и ангиопластики. Был диагностирован стойкий стеноз чревной артерии. Выполнена повторная операция открытым доступом с полной декомпрессией и спланхникганглионэктомией. В срок наблюдения 4 года – стойкая ремиссия, болевой синдром купирован и признаки рестеноза отсутствуют. При неэффективности миниинвазивных методов открытое хирургическое лечение обеспечивает надёжный и долгосрочный результат.

Celiac artery compression syndrome is a rare condition that causes chronic postprandial pain and weight loss, pathogenetically resulting from compression of the celiac trunk by the median arcuate ligament. This article presents a clinical case of an 18-year-old patient with recurrent symptoms following laparoscopic decompression and angioplasty, who was diagnosed with persistent stenosis of the celiac artery. A reoperation via an open approach was performed, involving complete decompression and splanchnic ganglionectomy. At the 4-year follow-up, sustained remission was observed: the pain syndrome was relieved, and no signs of restenosis were detected. When minimally invasive methods prove ineffective, open surgical treatment provides a reliable and long-term outcome.

Синдром Данбарасиндром компрессии чревного стволахроническая абдоминальная больэкстравазальная компрессия чревной артерииDunbar syndromeceliac trunk compression syndromechronic abdominal painextravasal compression of the celiac arteryReferencesGrotemeyer D, Duran M, Iskandar F, Blondin D, et al. Median arcuate ligament syndrome: vascular surgical therapy and follow-up of 18 patients. Langenbeck’s archives of surgery. 2009; 394(6): 1085-1092. doi: 10.1007/s00423-009-0509-5.Grotemeyer D, Duran M, Iskandar F, Blondin D, et al. Median arcuate ligament syndrome: vascular surgical therapy and follow-up of 18 patients. Langenbeck’s archives of surgery. 2009; 394(6): 1085-1092. doi: 10.1007/s00423-009-0509-5.Plate G, Eklöf B, Vang, J. The celiac compression syndrome: myth or reality? Acta chirurgica Scandinavica. 1981; 147(3): 201-203.Plate G, Eklöf B, Vang, J. The celiac compression syndrome: myth or reality? Acta chirurgica Scandinavica. 1981; 147(3): 201-203.Levin DC, Baltaxe HA. High incidence of celiac axis narrowing in asymptomatic individuals. The American journal of roentgenology, radium therapy, and nuclear medicine. 1972; 116(2): 426-429. doi: 10.2214/ajr.116.2.426.Levin DC, Baltaxe HA. High incidence of celiac axis narrowing in asymptomatic individuals. The American journal of roentgenology, radium therapy, and nuclear medicine. 1972; 116(2): 426-429. doi: 10.2214/ajr.116.2.426.Gümüş H, Gümüş M, Tekbaş G, Önder H, et al. Clinical and multidetector computed tomography findings of patients with median arcuate ligament syndrome. Clinical imaging. 2012; 36(5): 522-525. doi: 10.1016/j.clinimag.2011.11.031.Gümüş H, Gümüş M, Tekbaş G, Önder H, et al. Clinical and multidetector computed tomography findings of patients with median arcuate ligament syndrome. Clinical imaging. 2012; 36(5): 522-525. doi: 10.1016/j.clinimag.2011.11.031.Duncan AA. Median arcuate ligament syndrome. Current treatment options in cardiovascular medicine. 2008; 10(2): 112-116. doi: 10.1007/s11936-008-0012-2.Duncan AA. Median arcuate ligament syndrome. Current treatment options in cardiovascular medicine. 2008; 10(2): 112-116. doi: 10.1007/s11936-008-0012-2.Ho KKF, Walker P, Smithers BM, et al. Outcome predictors in median arcuate ligament syndrome. Journal of vascular surgery. 2017; 65(6): 1745-1752. doi: 10.1016/j.jvs.2016.11.040.Ho KKF, Walker P, Smithers BM, et al. Outcome predictors in median arcuate ligament syndrome. Journal of vascular surgery. 2017; 65(6): 1745-1752. doi: 10.1016/j.jvs.2016.11.040.Goodall R, Langridge B, Onida S, et al. Median arcuate ligament syndrome. Journal of vascular surgery. 2020; 71(6): 2170-2176. doi: 10.1016/j.jvs.2019.11.012.Goodall R, Langridge B, Onida S, et al. Median arcuate ligament syndrome. Journal of vascular surgery. 2020; 71(6): 2170-2176. doi: 10.1016/j.jvs.2019.11.012.Chaum M, Shouhed D, Kim S, Walts AE, et al. Clinico-pathologic findings in patients with median arcuate ligament syndrome (celiac artery compression syndrome). Annals of diagnostic pathology. 2021; 52: 151732. doi: 10.1016/j.anndiagpath.2021.151732.Chaum M, Shouhed D, Kim S, Walts AE, et al. Clinico-pathologic findings in patients with median arcuate ligament syndrome (celiac artery compression syndrome). Annals of diagnostic pathology. 2021; 52: 151732. doi: 10.1016/j.anndiagpath.2021.151732.Diab J, Diab V, Berney CR. A diagnostic workup and laparoscopic approach for median arcuate ligament syndrome. ANZ journal of surgery. 2022; 92(7-8): 1742-1747. doi: 10.1111/ans.17514.Diab J, Diab V, Berney CR. A diagnostic workup and laparoscopic approach for median arcuate ligament syndrome. ANZ journal of surgery. 2022; 92(7-8): 1742-1747. doi: 10.1111/ans.17514.Sultan S, Hynes N. PS160. Management of Median Arcuate Ligament Syndrome (MALS) with Decompression and Coeliac Ganglion Sympathectomy (CGS) for Chronic Mesenteric Ischaemia (CMI). Procedural, Clinical and Enduring Results With Quality-Adjusted Time Spent Without Symptoms of Disease and Toxicity of Treatment (Q-TWiST). Journal of Vascular Surgery. 2010; 51: 62S.Sultan S, Hynes N. PS160. Management of Median Arcuate Ligament Syndrome (MALS) with Decompression and Coeliac Ganglion Sympathectomy (CGS) for Chronic Mesenteric Ischaemia (CMI). Procedural, Clinical and Enduring Results With Quality-Adjusted Time Spent Without Symptoms of Disease and Toxicity of Treatment (Q-TWiST). Journal of Vascular Surgery. 2010; 51: 62S.Metz FM, Blauw JTM, Brusse-Keizer M, et al. Systematic Review of the Efficacy of Treatment for Median Arcuate Ligament Syndrome. European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery. 2022; 64(6): 720-732. doi: 10.1016/j.ejvs.2022.08.033.Metz FM, Blauw JTM, Brusse-Keizer M, et al. Systematic Review of the Efficacy of Treatment for Median Arcuate Ligament Syndrome. European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery. 2022; 64(6): 720-732. doi: 10.1016/j.ejvs.2022.08.033.Jimenez JC, Harlander-Locke M, Dutson EP. Open and laparoscopic treatment of median arcuate ligament syndrome. Journal of vascular surgery. 2012; 56(3): 869-873. doi: 10.1016/j.jvs.2012.04.057.Jimenez JC, Harlander-Locke M, Dutson EP. Open and laparoscopic treatment of median arcuate ligament syndrome. Journal of vascular surgery. 2012; 56(3): 869-873. doi: 10.1016/j.jvs.2012.04.057.Skelly CL, Stiles-Shields C, Mak GZ, et al. The impact of psychiatric comorbidities on patientreported surgical outcomes in adults treated for the median arcuate ligament syndrome. Journal of vascular surgery. 2018; 68(5): 1414-1421. doi: 10.1016/j.jvs.2017.12.078.Skelly CL, Stiles-Shields C, Mak GZ, et al. The impact of psychiatric comorbidities on patientreported surgical outcomes in adults treated for the median arcuate ligament syndrome. Journal of vascular surgery. 2018; 68(5): 1414-1421. doi: 10.1016/j.jvs.2017.12.078.Berge ST, Safi N, Medhus AW, Sundhagen JO, et al. Perioperative Microcirculatory Changes Detected with Gastroscopy Assisted Laser Doppler Flowmetry and Visible Light Spectroscopy in Patients with Median Arcuate Ligament Syndrome. Vascular health and risk management. 2020; 16: 331-341. doi: 10.2147/VHRM.S252192.Berge ST, Safi N, Medhus AW, Sundhagen JO, et al. Perioperative Microcirculatory Changes Detected with Gastroscopy Assisted Laser Doppler Flowmetry and Visible Light Spectroscopy in Patients with Median Arcuate Ligament Syndrome. Vascular health and risk management. 2020; 16: 331-341. doi: 10.2147/VHRM.S252192.Mak GZ, Speaker C, Anderson K, et al. Median arcuate ligament syndrome in the pediatric population. Journal of pediatric surgery. 2013; 48(11): 2261-2270. doi: 10.1016/j.jpedsurg.2013.03.003.Mak GZ, Speaker C, Anderson K, et al. Median arcuate ligament syndrome in the pediatric population. Journal of pediatric surgery. 2013; 48(11): 2261-2270. doi: 10.1016/j.jpedsurg.2013.03.003.

The authors declare that there are no conflicts of interest present.