In 1963 Harjola <sup>15 Harjola P.T. A rare obstruction of the coeliac artery Ann Chir Gynaec Fenniae 1963 ;  52 : 547

Cliccare qui per andare alla sezione Riferimenti</sup> described a case of chronic abdominal pain in a young woman that he attributed to mesenteric ischemia, which in turn was caused by extrinsic compression of the celiac artery (CA). The CA compression syndrome (also known as median arcuate ligament [MAL] compression syndrome, celiac band syndrome, and Dunbar's syndrome) has generated debate among surgeons ever since. All agree that if it does exist, the syndrome is rare, and thus knowledge about it will continue to depend on case reports and small institutional series. Even those who are convinced that extrinsic compression of the celiac axis by ligamentous and neural structures can be a cause of abdominal pain admit that the pathophysiology of the pain is obscure because stenosis of a single mesenteric trunk, it is commonly held, should not result in visceral ischemia. No clear diagnostic criteria have been developed, and no imaging modality is both sensitive and specific for predicting response to treatment. Nevertheless, over the last 30 years many surgeons have cared for patients who fit the unusual clinical profile of a young patient with chronic mesenteric ischemia and have successfully relieved long-standing pain with a safe and relatively simple operation. Unfortunately, because of the continuing disagreement that characterizes the literature of CA compression syndrome, effective treatment is probably denied to some patients who indeed suffer from it. The bias of the author of this article, based on personal experience of successful treatment of several patients, is that a strong case can be made for the existence of the syndrome. Accordingly, this review addresses the problems of pathophysiology and diagnosis that continue to create doubt.