The Dunbar's syndrome - renaissance of a controversial disease pattern

History and admission findings: A 79-year-old woman (BMI 23) presented with postprandial, occasionally epigastric, occasionally diffuse abdominal pain. Investigations: No pathologic findings in the physical examination and in the chemical analysis. Continuative examinations: Gastroscopy revealed a mild, non-reactive gastritis which was alleged not to be the cause of the symptoms. In ultrasonography arteriosclerotic lesions were seen, which led to the differential diagnosis of compensated angina abdominalis. On that assumption a CT-angiography was performed, which revealed a typical focal narrowing of the celiac axis about 1,5 cm distal of its origin in combination with hypertrophic collaterals between the celiac axis and the upper mesenteric artery. Diagnosis, treatment and course: In view of all findings, the diagnosis of Dunbar's syndrome was established. Since the symptoms were moderate, no further therapy was carried out. Conclusion: Dunbar's syndrome is caused by deep crossing of the median arcuate ligament resulting in compression of the proximal celiac axis resulting in a characteristic hooked appearance. Since a good collateralisation between the celiac axis and the superior mesenteric artery can be found, only about one percent of patients display symptoms (postprandial pain, sometimes weight loss). Typical patients are 20-40 year-old women. Although the diagnosis can be difficult and symptoms are rare, the Dunbar's syndrome, if typical morphologic findings an epigastric postprandial pain are present, is a relevant differential diagnosis.