Twenty patients with celiac axis compression were treated surgically during a 5-year period. Fifteen remain asymptomatic, two are partially improved, two are unimproved, and one has been lost to follow-up. The main presenting symptom was upper abdominal pain--constant in some, intermittent in most--and the main diagnostic clue was a loud, localized systolic bruit in the midepigastrium. All had angiographic confirmation of the diagnosis. Ten had previous surgery (appendectomy, cholecystectomy, vagotomy, and pyloroplasty), without relief. The authenticity of celiac axis compression as a symptom-producing entity is difficult to establish objectively because the main treatable symptom is pain. However, eight of these patients gained weight, three have shown improvement in pancreatic function, and one of the unimproved patients still has an occluded celiac axis. A critical review of the literature of this controversial topic is included.