The authors present their experience at the Hôpital St-Luc in Montreal with seven patients who had celiac compression syndrome. All underwent section of the median arcuate ligament to free the celiac axis and resection of the connecting nerve fibers of the solar plexus (periarterial neurectomy). At a mean follow-up of 36 months all patients were asymptomatic. In some cases, extrinsic compression of the celiac axis by the arcuate ligament can explain upper abdominal plain. An epigastric bruit in the presence of a normal digestive tract is an indication for lateral aortography to detect extrinsic compression. The pain in this syndrome cannot be explained solely on hemodynamic grounds; surgical treatment should include release of the celiac axis and complete periarterial neurectomy.