Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice
| Autor: | ER Faulconer, R. Downing, A Perry, SJ Robinson, GC Kirby |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Superior Mesenteric Artery Syndrome medicine.medical_treatment Jejunostomy Anastomosis Epigastric pain Young Adult 03 medical and health sciences 0302 clinical medicine medicine.artery Duodenostomy medicine Humans Superior mesenteric artery Upper GI surgery Aged business.industry General Medicine Middle Aged Bleed medicine.disease Surgery medicine.anatomical_structure 030220 oncology & carcinogenesis Duodenum Vomiting Female Laparoscopy 030211 gastroenterology & hepatology medicine.symptom business Superior mesenteric artery syndrome |
| Zdroj: | The Annals of The Royal College of Surgeons of England. 99:472-475 |
| ISSN: | 1478-7083 0035-8843 |
| DOI: | 10.1308/rcsann.2017.0063 |
| Popis: | INTRODUCTION The superior mesenteric artery (SMA) syndrome, or Wilkie’s syndrome, is a rare cause of postprandial epigastric pain, vomiting and weight loss caused by compression of the third part of the duodenum as it passes beneath the proximal superior mesenteric artery. The syndrome may be precipitated by sudden weight loss secondary to other pathologies, such as trauma, malignancy or eating disorders. Diagnosis is confirmed by angiography, which reveals a reduced aorto-SMA angle and distance, and contrast studies showing duodenal obstruction. Conservative management aims to increase intra-abdominal fat by dietary manipulation and thereby increase the angle between the SMA and aorta. Where surgery is indicated, division of the ligament of Treitz, anterior transposition of the third part of the duodenum and duodenojejunostomy have been described. METHODS We present four cases of SMA syndrome where the intention of treatment was laparoscopic duodenojejunostomy. The procedure was completed successfully in three patients, who recovered quickly with no short-term complications. A fourth patient underwent open gastrojejunostomy (complicated by an anastomotic bleed) when dense adhesions prevented duodenojejunostomy. CONCLUSIONS The superior mesenteric artery syndrome should be considered in patients with epigastric pain, prolonged vomiting and weight loss. Laparoscopic duodenojejunostomy is a safe and effective operation for management of the syndrome. A multi-speciality team approach including gastrointestinal, vascular and radiological specialists should be invoked in the management of these patients. |
| Databáze: | OpenAIRE |
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