#23 THE USE OF GASTRIC TONOMETRY IN THE
ASSESSMENT OF CELIAC ARTERY COMPRESSION SYNDROME.
Peter L. Faries, MD, Anil Narula, MD, Frank J. Veith, MD, Ben U.
Marsan, MD, Frank W. LoGerfo, MD, and Frank B. Pomposelli, Jr.,
MD.
Beth Israel Deaconess Medical Center/Harvard Institutes of Medicine,
Boston, MA
Work performed at Montefiore Medical Center, Bronx, NY.
Compression of the celiac axis by the median arcuate ligament (MAL)
is thought to result in a variant form of chronic intestinal
ischemia. Difficulty has been encountered, however, in documenting
intestinal ischemia and in establishing a link between the symptoms
of abdominal pain and weight loss and the angiographic finding of
extrinsic compression of the celiac artery (CA) by the MAL. We
sought to determine whether gastric mucosal blood flow was impaired
by CA compression and whether mucosal blood flow could be improved by
MAL release in a patient treated for celiac artery compression
syndrome. Gastric tonometry was used to determine intestinal mucosal
pH (pHi) and blood flow. The 26-yr old male patient experienced
postprandial abdominal pain, ""ood fear""and a 40-lb weight loss. He
had a normal abdominal ultrasound, computed tomography scan and
esophagogastroduodenoscopy. Mesenteric angiography demonstrated
compression of the CA, exacerbated during deep expiration.
Significant gastric mucosal ischemia was demonstrated prior to celiac
artery decompression as indicated by a preoperative pHi of 7.29
(normal, 7.38-7.48). The ischemia was relieved by celiac artery
decompression with an increase in the pHi to 7.48. The patient
experienced complete relief of his symptoms after surgical
decompression and has gained 8 lb in the ensuing 4 months. This
represents the first use of gastric tonometry to provide an objective
measurement of intestinal perfusion and ischemia in the treatment of
celiac artery compression syndrome.
