Introduction: Compression of the celiac artery by the diaphragmatic crura, the median arcuate ligament, or the fibrous periaortic ganglionic tissue results in a rare constellation of symptoms known as celiac artery compression syndrome (CACS).
Anatomy: First described in 1963 by Harjola in a patient with symptoms of mesenteric ischemia, it remains an elusive diagnosis.
Clinical presentation: Patients commonly present with a wide variety of symptoms resulting in multiple diagnostic tests.
Diagnosis: A firm diagnosis is difficult to establish, and treatment is equally challenging. These challenges are illustrated by the following case series, and evidence supporting current treatment modalities is reviewed.
Treatment: We describe a laparoscopic approach to decompression of the celiac artery facilitated by intraoperative ultrasound.