1517 Case Report: Concomitant Superior Mesenteric Artery and Nutcracker Syndrome
| Autor: | M G Rivera Cartland, R Camprodon |
|---|---|
| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | British Journal of Surgery. 108 |
| ISSN: | 1365-2168 0007-1323 |
| DOI: | 10.1093/bjs/znab259.384 |
| Popis: | Background Superior mesenteric artery (SMA) syndrome is a rare1 upper gastrointestinal emergency and diagnosis is reached by a high clinical suspicion and confirmed on CT scan. It classically occurs from the compression of the third part of the duodenum (D3) due to a reduced aorto-mesenteric angle2. Case report A 28-year-old Caucasian female presented with a 4-day history of persistent vomiting, generalised abdominal pain, distension and absolute constipation for 3 days. She has no previous past medical history. On examination, she had a BMI of 17. Her abdomen was distended with generalised tenderness on palpation. Her routine blood results showed stage 2 acute renal failure. CT abdomen and pelvis showed a grossly dilated stomach and part 1& 2 of duodenum. She underwent an emergency Roux-en-Y duodeno-jejunostomy and end-side jejuno-jejunal anastomosis. Operative findings were of a grossly distended stomach and D1/2 with superior mesenteric vessels impinging on D3 and on left renal vein. Conclusions SMA syndrome is a rare cause of gastric outlet obstruction and following initial hydration and correction of electrolytes a definitive procedure should be considered. Many surgeons favour a conservative approach with a period of ‘fattening’ to increase the aorto-mesenteric angle prior to surgical management. We believe that this only delays the inevitable and patients are best serviced with early surgical bypass. References 1. Biswas A. Superior mesenteric artery syndrome: CT findings. BMJ Case Rep. 2016 2. Multidetector CT of vascular compression syndromes in the abdomen and pelvis. RadioGraphics 2014;34:93–115. 10.1148/rg.341125010 |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|