Exercise-related abdominal pain as a manifestation of the median arcuate ligament syndrome

Abdominal pain related to exercise, often loosely referred to as 'stitch', is not uncommon, particularly among participants in sports that involve running. The cause of this typically transient pain is poorly understood with several aetiologies proposed including diaphragmatic ischaemia (&;lt;citeref rid="b1"&;gt;1&;lt;/citeref&;gt;,?&;lt;citeref rid="b2"&;gt;2&;lt;/citeref&;gt;). Other gastrointestinal symptoms that are common during prolonged or high-intensity exercise include nausea, diarrhoea and gastrointestinal bleeding (&;lt;citeref rid="b3"&;gt;3&;lt;/citeref&;gt;,?&;lt;citeref rid="b4"&;gt;4&;lt;/citeref&;gt;). These symptoms are also usually transient and are thought to protect against critical organ damage by promoting cessation of exercise. Decreased gastrointestinal blood flow, increased motility and altered neuroendocrine modulation are postulated disease mechanisms (&;lt;citeref rid="b3"&;gt;3&;lt;/citeref&;gt;). We report here a case of an elite runner with exercise-related severe abdominal pain and diarrhoea related to compression of the coeliac axis by the median arcuate ligament. Complete symptom relief was achieved with surgical division of the constricting ligament. The clinical characteristics and pathogenesis of coeliac axis compression syndrome are discussed.