Symptoms of Celiac Trunk Stenosis in Adults with Atherosclerotic Risk Factors
The classic symptom triad consists of postprandial abdominal pain (occurring 15-30 minutes after eating), fear of eating due to pain avoidance, and progressive unintended weight loss—though many patients remain asymptomatic for prolonged periods due to collateral circulation from the superior mesenteric artery. 1
Primary Clinical Manifestations
Postprandial Abdominal Pain
- Painful abdominal cramps and colic occurring typically 15-30 minutes after eating, present in nearly 100% of symptomatic patients 1
- Pain is characteristically epigastric in location 2
- The pain intensity leads to learned food avoidance behavior 1
Food Fear and Weight Loss
- Patients develop fear of eating (sitophobia) as a learned response to prevent pain, despite preserved appetite—this distinguishes them from malignancy patients 3, 1
- Progressive unintended weight loss occurs due to reduced oral intake from pain avoidance, not initially from malabsorption 1
Additional Gastrointestinal Symptoms
- Nausea and vomiting may occur as part of ischemic gastropathy 3, 1
- Diarrhea or constipation can develop 3, 1
- Malabsorption occurs only in advanced cases 1
- Anorexia and bloating are reported 2
Physical Examination Findings
- Abdominal bruit may be audible on examination 1
- Signs of malnutrition including hypoalbuminemia, anemia, and electrolyte abnormalities may be present in advanced cases 1
- Physical findings are often minimal relative to symptom severity 3
Critical Clinical Context
Asymptomatic Presentation
- Most patients with celiac trunk stenosis remain asymptomatic for prolonged periods due to abundant collateral circulation through pancreaticoduodenal arcades from the superior mesenteric artery 1, 4, 2, 5
- Stenosis of one or even two visceral vessels is usually well tolerated 3, 1
- Symptoms typically require stenosis or occlusion of at least two mesenteric arteries 3, 1
Risk Factors and Associated Conditions
- Advanced age (>65 years shows 18% prevalence of asymptomatic stenosis) 3
- Diffuse atherosclerotic disease including coronary artery disease 3
- Hypertension, diabetes mellitus, smoking, and hypercholesterolemia 3, 1
- Presence of abdominal aortic aneurysm (40% have visceral artery stenosis) 3
- Aortoiliac or lower extremity arterial disease 3, 1
Acute Presentation Warning Signs
If acute mesenteric ischemia develops from thrombotic occlusion, patients present with sudden severe abdominal pain out of proportion to examination findings, accompanied by bowel emptying (vomiting, diarrhea), and peritoneal signs if bowel infarction occurs 3, 1
Common Pitfalls
- Do not dismiss symptoms in patients with single-vessel celiac stenosis if they have concurrent superior mesenteric artery disease, as inadequate collaterals can result in symptomatic ischemia 3
- Consider alternative diagnoses if symptoms persist after intervention, as celiac compression may be incidental rather than causative 6
- Laboratory tests (lactate, lactate dehydrogenase, leucocyte count) are unhelpful in chronic mesenteric ischemia diagnosis 3