Chronic Mesenteric Ischemia Presenting as Exercise-induced Abdominal Pain

Patients with a stenosis of the superior mesenteric artery and a widely patent celiac axis are often asymptomatic because of a rich network of collaterals between the two. Compression of the celiac axis by the diaphragm is, in patients without additional vascular disease, also frequently asymptomatic. Here, we describe an unusual case of exercise-induced abdominal pain caused by a combination of these two pathologies. In our patient with a previously occluded inferior mesenteric artery and a 90% superior mesenteric artery stenosis, celiac compression by the diaphragm, worsened with exercise, caused severe abdominal pain. This exercise-induced pain resolved completely with endovascular treatment of the superior mesenteric artery stenosis.