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1.
Rev. bras. ortop ; 56(4): 523-527, July-Aug. 2021. graf
Article in English | LILACS | ID: biblio-1341167

ABSTRACT

Abstract Vascular compression of the third part of the duodenum by the superior mesenteric artery results in an unusual occlusion of the duodenal transit known as superior mesenteric artery syndrome. This syndrome can occur after surgeries to correct spinal deformities in a rate ranging from 0.5% to 4.7%. It results from a positional alteration of the artery emergency point due to a change in trunk length after surgery. It is associated with risk factors such as low body mass index and weight loss. Patients usually present with intestinal occlusion, abdominal pain, nausea, bilious vomiting, and early satiety. Superior mesenteric artery syndrome must be recognized early to institute an adequate treatment, which can be clinical (with gastric tube for decompression and nutritional support) or require a surgical procedure. Secondary complications related to superior mesenteric artery syndrome include delayed surgical and nutritional recovery, healing problems, and prolonged hospitalization. The present study aims to report a case of superior mesenteric artery syndrome in a patient with neuromuscular scoliosis secondary to a transverse myelitis who underwent surgical treatment for spinal deformity correction.


Resumo A compressão vascular da terceira parte do duodeno pela artéria mesentérica superior resulta no desenvolvimento de uma condição incomum de oclusão do trânsito duodenal conhecida como síndrome da artéria mesentérica superior. Este fenômeno pode acontecer após cirurgias de correção de deformidades da coluna, e sua taxa de ocorrência é de 0,5 a 4,7% dos casos. Isso ocorre em virtude da alteração do posicionamento do ponto de emergência da artéria, decorrente da mudança do comprimento do tronco após a cirurgia, e está associado a fatores de risco, como baixo índice de massa corpórea e perda ponderal. Os pacientes costumam se apresentar com um quadro de oclusão intestinal, com dor abdominal, náusea, vômito bilioso e saciedade precoce. O reconhecimento desta condição é importante para instituir o tratamento adequado, que varia do tratamento clínico, com sondagem e descompressão gástrica associados a suporte nutricional; à necessidade de abordagem cirúrgica. Complicações secundárias relacionadas à síndrome da artéria mesentérica superior incluem: recuperação cirúrgica e nutricional retardadas, problemas com a cicatrização e hospitalização prolongada. O objetivo do presente estudo é relatar um caso de síndrome da artéria mesentérica superior, ocorrido em um paciente com escoliose neuromuscular secundária a sequela de mielite transversa, submetido ao tratamento cirúrgico da deformidade da coluna.


Subject(s)
Humans , Male , Child , Scoliosis/surgery , Spinal Fusion , Superior Mesenteric Artery Syndrome/complications , Intestinal Obstruction
2.
Rev. habanera cienc. méd ; 20(3): e3674, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1280438

ABSTRACT

Introducción: El Síndrome de la Arteria Mesentérica Superior es causa poco frecuente de obstrucción duodenal. Los síntomas varían desde una obstrucción leve hasta emergencias agudas. El examen físico no siempre ayuda al diagnóstico, que se basa en los hallazgos imagenológicos. Objetivo: preconizar, recomendar el uso de las técnicas mínimamente invasivas en el manejo quirúrgico del Síndrome de la Arteria Mesentérica Superior. Presentación del caso: Mujer de 49 años de edad, antecedentes de pérdida de peso después de quimioterapia con náuseas, vómitos y dolor abdominal posprandial de dos años de evolución. Tratada exitosamente con duodenoyeyunostomía laparoscópica. El tratamiento inicial suele ser conservador. Publicaciones recientes respaldan que la duodenoyeyunostomía laparoscópica es un método seguro y efectivo para su tratamiento. Conclusiones: El tratamiento quirúrgico es cada vez más exitoso, la mayoría de los pacientes no presenta síntomas después de la cirugía(AU)


Introduction: Superior Mesenteric Artery Syndrome is an uncommon cause of duodenal obstruction. Symptoms may vary from mild obstruction to acute life-threatening emergencies. Physical examination does not always help in establishing the diagnosis which is based on findings from imaging studies. Objective: To recommend the laparoscopic approach for the surgical treatment of this entity. Case presentation: A 49-year old female patient with prior history of weight loss after chemotherapy and a two-year history of postprandial nausea, vomiting, and abdominal pain who was successfully treated by laparoscopic duodenojejunostomy is presented. Discussion: Initial treatment is usually conservative. Recently published studies support that laparoscopic duodenojejunostomy is a safe and effective method of treatment. Conclusions: Surgical treatment is becoming more successful and the majority of patients are symptom-free after surgery(AU)


Subject(s)
Humans , Female , Middle Aged , Superior Mesenteric Artery Syndrome/therapy , Abdominal Pain , Drug Therapy , Duodenal Obstruction/complications , Weight Loss , Duodenoscopy/methods
3.
Rev. guatemalteca cir ; 27(1): 48-51, 2021. ilus
Article in Spanish | LILACS, LIGCSA | ID: biblio-1372408

ABSTRACT

El síndrome de arteria mesentérica superior (SAMS), causa infrecuente de obstrucción intestinal proximal; ocurre por compresión externa de la tercera porción duodenal por la arteria mesentérica superior debido a la formación de un ángulo inadecuado de la unión aortomesentérica. Incidencia de 0.013% - 0.3. Se presenta caso de paciente masculino de 27 años con diagnóstico de SAMS, historia de pérdida de peso, dolor postprandial recurrente, náuseas, vómitos de contenido biliar de un año de evolución. Paciente se ingresa al servicio de emergencia de Cirugía de Adultos del Hospital Roosevelt, Guatemala, donde se programa y realiza abordaje con técnica de Strong, además de la realización de duodeno-yeyuno anastomosis. Evoluciona satisfactoriamente por lo que se concluye que la técnica de Strong aunada a la realización de duodeno-yeyuno anastomosis son herramientas más efectivas como abordaje quirúrgico del síndrome de arteria mesentérica superior. (AU)


The superior mesenteric artery syndrome (SAMS), a rare cause of proximal intestinal obstruction; It occurs by external compression of the third duodenal portion by the superior mesenteric artery due to the formation of an inappropriate angle of the aortomesenteric junction. Incidence of 0.013% - 0.3. A case of a 27-year-old male patient is presented with a diagnosis of SAMS, history of weight loss, recurrent postprandial pain, nausea, vomiting of bile content of one year of evolution. Patient is admitted to the emergency service of Adult Surgery of the Roosevelt Hospital, Guatemala, where an approach with Strong's technique is programmed and performed in addition to the duodenum-jejunum anastomosis, it evolves satisfactorily, which is why it is concluded that the Strong's technique combined duodenum-jejunum anastomosis are more effective tools as a surgical approach to superior mesenteric artery syndrome. (AU)


Subject(s)
Humans , Male , Adult , Superior Mesenteric Artery Syndrome/surgery , Superior Mesenteric Artery Syndrome/diagnostic imaging , Anastomosis, Surgical/methods , Tomography, X-Ray Computed
4.
Clin. biomed. res ; 40(2): 137-139, 2020. ilus
Article in Portuguese | LILACS | ID: biblio-1148103

ABSTRACT

A síndrome da artéria mesentérica superior (SAM), ou síndrome de Wilkie, é uma afecção rara que acomete geralmente indivíduos jovens do sexo feminino. Caracterizada pela obstrução parcial ou completa do duodeno devido à compressão pela artéria mesentérica superior anteriormente, e pela aorta, posteriormente. Apresentamos um caso não usual de SAM, em paciente idosa, diagnosticado através de história clínica e imagem tomográfica característica. Indicou-se manejo cirúrgico de derivação jejunal e anastomose com duodeno acima da obstrução, na ciência do risco do procedimento. A paciente apresentou excelente evolução e encontra-se assintomática. O diagnóstico precoce, através de uma anamnese adequada e uso dos critérios radiológicos já definidos em literatura, podem afetar positivamente o desfecho dos pacientes portadores em qualquer faixa etária. (AU)


Superior mesenteric artery syndrome (SMAS), or Wilkie syndrome, is a rare condition that usually affects young women. It is characterized by partial or complete obstruction of the duodenum due to compression by the superior mesenteric artery anteriorly and by the aorta posteriorly. We report an unusual case of SMAS in an older woman diagnosed using clinical history and tomographic imaging. Surgical management consisting of jejunal shunt and anastomosis with duodenum above the obstruction was indicated despite the risk of the procedure. The outcome was excellent, and the patient is asymptomatic. Early diagnosis using adequate anamnesis and radiological criteria defined in the literature may positively influence the outcome of patients from any age group. (AU)


Subject(s)
Humans , Female , Aged, 80 and over , Superior Mesenteric Artery Syndrome/surgery , Superior Mesenteric Artery Syndrome/diagnosis , Rare Diseases/surgery
5.
Arch. argent. pediatr ; 117(6): 648-650, dic. 2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1046632

ABSTRACT

El síndrome de la arteria mesentérica superior es una enfermedad poco frecuente en pediatría. Se produce por la compresión de la tercera porción duodenal a su paso entre la arteria mesentérica superior y la aorta abdominal (compás aortomesentérico). La mayoría de los pacientes presentan factores predisponentes:pérdida de peso aguda o compresiones extraabdominales.Se presenta el caso de una niña de 12 años de edad a quien se le diagnosticó el síndrome sin presentar factores predisponentes.Comenzó de modo súbito con náuseas, vómitos incoercibles y dolor abdominal, que era posprandial y se aliviaba, llamativamente, en decúbito lateral izquierdo. Esto constituyó la sospecha clínica del síndrome, por lo que se solicitó una angio tomografía computada abdominal y se observó el estrechamiento del compás aortomesentérico. Se realizó un tratamiento médico conservador, sin respuesta clínica. Se decidió el tratamiento quirúrgico y se logró la resolución del cuadro clínico


The superior mesenteric artery syndrome is rarely seen in children. It results from an intestinal obstruction due to compression of the third portion of duodenum between the superior mesenteric artery and the abdominal aorta. In most of the cases there are predisposing factors such as rapid weight loss or extra-abdominal compression.We report a case of a superior mesenteric artery syndrome in a twelve-year-old female patient without predisposing factors. The girl began suddenly with nauseas, continuous vomiting and abdominal pain. The abdominal pain was postprandial and it decreased in left lateral decubitus position. Clinically, this characteristic suggested superior mesenteric artery syndrome. Angio-computed tomography scan confirmed the diagnosis. Given that conservative treatment ultimately failed, patient was subjected to surgery and the illness was resolved.


Subject(s)
Humans , Female , Child , Superior Mesenteric Artery Syndrome/surgery , Superior Mesenteric Artery Syndrome/diagnostic imaging , Jejunostomy , Duodenal Diseases/diagnostic imaging , Duodenal Obstruction
6.
Article in Korean | WPRIM | ID: wpr-765779

ABSTRACT

Bariatric surgery is the most effective and durable treatment for morbidly obese patients. However, there are remained unsolved problems with various types of complications. Superior mesenteric artery syndrome is a rarely known condition occurred following bariatric surgery. We experienced 54-year-old female patient diagnosed with superior mesenteric artery syndrome 5 year later after laparoscopic adjustable gastric banding. Because symptoms have not improved with conservative care, laparoscopic duodenojejunal bypass was successfully performed for this patient.


Subject(s)
Bariatric Surgery , Female , Humans , Mesenteric Artery, Superior , Middle Aged , Superior Mesenteric Artery Syndrome
7.
Article in English | WPRIM | ID: wpr-717558

ABSTRACT

Cases of repeated acute gastric dilatations after binge eating in one patient are rarely reported. We report here a case of repeated acute gastric dilatations in a 22-year-old woman with bulimia nervosa. Her repeated acute gastric dilatations seem to have been related to superior mesenteric artery syndrome. On her last visit due to acute gastric dilatation, she underwent emergency gastric decompression surgery because of abdominal compartment syndrome; however, she eventually died because of ischemia reperfusion injury. Emergency physicians should be aware of the need to manage acute gastric dilatation in patients with eating disorder and should pay attention to the signs and distinctive clinical features of abdominal compartment syndrome.


Subject(s)
Bulimia Nervosa , Bulimia , Decompression , Dilatation , Eating , Emergencies , Female , Gastric Dilatation , Humans , Intra-Abdominal Hypertension , Reperfusion Injury , Superior Mesenteric Artery Syndrome , Young Adult
8.
Article in English | WPRIM | ID: wpr-739194

ABSTRACT

Nutcracker syndrome is a phenomenon that the left renal vein (LRV) is pressed between the superior mesenteric artery (SMA) and the aorta. Clinical characteristics include gross or microscopic hematuria, orthostatic proteinuria, abdominal pain, and back pain. It occurs due to LRV squeezing caused by narrowed aortomesenteric angle. SMA syndrome is a disease that the third part of the duodenum is prone to intestinal obstruction by narrowed angle between the SMA and the abdominal aorta. Clinical symptoms include postprandial abdominal distension, epigastric pain, nausea, and vomiting. SMA syndrome and nutcracker syndrome have common features that result from narrowed aortomesenteric angle. However, it is very rare for both syndromes to occur simultaneously, so the two syndromes are regarded as separate diseases. This is a report on a case of nutcracker syndrome with SMA syndrome in a child who presented gross hematuria, recurrent abdominal pain and vomiting. To our knowledge, nutcracker syndrome simultaneous with SMA syndrome has not been previously reported in pediatric patient, especially with an exhibition of gross hematuria. This case suggests that the simultaneous presence of SMA syndrome with the same pathogenesis needs to be considered when nutcracker syndrome is suspected in pediatric patients with hematuria.


Subject(s)
Abdominal Pain , Aorta , Aorta, Abdominal , Back Pain , Child , Duodenum , Hematuria , Humans , Intestinal Obstruction , Mesenteric Artery, Superior , Nausea , Proteinuria , Renal Veins , Superior Mesenteric Artery Syndrome , Vomiting
9.
Rev. colomb. cir ; 33(3): 299-306, 2018. tab, fig
Article in Spanish | LILACS, COLNAL | ID: biblio-915812

ABSTRACT

Introducción. La compresión de la tercera porción del duodeno debido a la formación de un ángulo inadecuado de la unión aortomesentérica, se configura como el síndrome de arteria mesentérica superior o síndrome de Wilkie. Se trata de una entidad rara, de modo que es escaso su reporte en la literatura y poco aplicado su manejo quirúrgico mínimamente invasivo. Materiales y métodos. Se hace una revisión no sistemática de la literatura y posteriormente se expone el caso de un paciente con síndrome de Wilkie. Se muestran las imágenes de tomografías y un vídeo del procedimiento quirúrgico al que fue sometido. Discusión. El tratamiento quirúrgico del síndrome de la arteria mesentérica superior es el último recurso que se ofrece en pacientes con esta entidad. La duodenoyeyunostomía es el procedimiento con mejor evidencia en pacientes con compromiso severo del estado nutricional. Se describen los puntos esenciales de esta técnica utilizada en el caso que se reporta. Conclusiones. Cualquier entidad que cause la disminución del paquete graso entre la arteria mesentérica superior y la aorta puede causar síndrome de la arteria mesentérica superior. El diagnóstico es de exclusión y constituye un reto para el equipo médico. El tratamiento inicial es conservador, en tanto que la última opción es el manejo quirúrgico, idealmente por vía laparoscópica. Dentro de las técnicas mínimamente invasivas, la duodenoyeyunostomía es una buena herramienta


Introduction: Compression of the third portion of the duodenum due to an inappropriate angle of the aortamesenteric junction is known as the superior mesenteric artery syndrome or Wilkie's syndrome. A rare entity, reason why the reports in the literature are scarce and the minimally invasive surgical management is scarcely used. Materials and methods: A non-systematic review of the literature was carried out, and the case of a patient with Wilkie's syndrome is reported. The images, tomographies and a video of the surgical procedure are presented.Discussion: The surgical management of the superior mesenteric artery syndrome is the ultimate management to be offered in patients with this entity. Duodenojejunostomy is the procedure with the best evidence to be offered to patients with severe malnutrition. The essential points of this technique, used for the case reported, are described. Conclusions: Any entity that causes the reduction of the fatty pack between the superior mesenteric artery and the aorta can cause superior mesenteric artery syndrome. The diagnosis is made by exclusion and constitutes a challenge for the medical team. The initial treatment is conservative, and the last option is the surgical management, ideally laparoscopic; among the minimally invasive techniques, duodenojejunostomy is a good tool


Subject(s)
Humans , Superior Mesenteric Artery Syndrome , Anastomosis, Surgical , Minimally Invasive Surgical Procedures , Duodenal Obstruction
10.
Article in English | WPRIM | ID: wpr-51507

ABSTRACT

Superior mesenteric artery (SMA) syndrome is one of the rare causes of small bowel obstruction. It develops following a marked decrease in the angle between SMA and the abdominal aorta due to weight loss, anatomical anomalies, or following surgeries. Nutcracker syndrome in the left renal vein may also occur following a decrease in the aortomesenteric angle. Though SMA syndrome and renal nutcracker syndrome share the same pathogenesis, concurrent development has rarely been reported. Herein, we report a 23-year-old healthy male diagnosed with SMA syndrome and renal nutcracker syndrome due to severe weight reduction. The patient visited our outpatient clinic presenting bilious vomiting and indigested vomitus for 3 consecutive days. He had lost 20 kg during military service. We suspected SMA syndrome based on abnormal air-shadow in the stomach and small bowel on abdominal X-ray; we confirmed compression of the third portion of the duodenum with upper gastrointestinal series and abdominal computed tomography (CT). Concurrently, renal nutcracker syndrome was also detected via abdominal CT and Doppler ultrasound. Considering bilious vomiting and no urinary symptoms, SMA syndrome was corrected by laparoscopic duodenojejunostomy, and close observation for the renal nutcracker syndrome was recommended.


Subject(s)
Ambulatory Care Facilities , Aorta, Abdominal , Duodenum , Humans , Intestinal Obstruction , Laparoscopy , Male , Mesenteric Artery, Superior , Military Personnel , Renal Nutcracker Syndrome , Renal Veins , Stomach , Superior Mesenteric Artery Syndrome , Tomography, X-Ray Computed , Ultrasonography , Vomiting , Weight Loss , Young Adult
12.
Article in English | WPRIM | ID: wpr-91786

ABSTRACT

Superior mesenteric artery (SMA) syndrome is a rare condition that must be differentiated from other gastrointestinal diseases manifesting as upper abdominal pain, nausea, or vomiting. The description of SMA syndrome is compression of the third portion of the duodenum by the SMA and the abdominal aorta. SMA syndrome is managed with nasoenteral nutrition or surgical strategies such as laparoscopic duodenojejunostomy. However, SMA syndrome treated using enteral nutrition by percutaneous radiologic gastrojejunostomy has not been reported. Here, we report our experience of successfully managing a case of SMA syndrome with percutaneous radiologic gastrojejunostomy.


Subject(s)
Abdominal Pain , Aorta, Abdominal , Duodenal Obstruction , Duodenum , Enteral Nutrition , Gastric Bypass , Gastrointestinal Diseases , Mesenteric Artery, Superior , Nausea , Superior Mesenteric Artery Syndrome , Vomiting
13.
Singapore medical journal ; : 274-278, 2016.
Article in English | WPRIM | ID: wpr-296420

ABSTRACT

A 16-year-old Chinese male patient presented with constipation lasting five days, colicky abdominal pain, lethargy, weakness and body aches. He was able to pass flatus. Abdominal radiography showed a distended stomach causing inferior displacement of the transverse colon. Computed tomography revealed a dilated oesophagus, stomach and duodenum up to its third portion, with a short aortomesenteric distance and narrow angle. There was also consolidation in the lungs bilaterally. Based on the constellation of clinical and imaging findings, a diagnosis of superior mesenteric artery syndrome complicated by aspiration pneumonia was made. The patient was subsequently started on intravenous hydration, nasogastric tube aspiration and antibiotics. Following stabilisation of his acute condition, a nasojejunal feeding tube was inserted and a feeding plan was implemented to promote weight gain. The clinical presentation, differentials, diagnosis and treatment of superior mesenteric artery syndrome are discussed.


Subject(s)
Adolescent , Aged , Child , China , Duodenum , Diagnostic Imaging , Enteral Nutrition , Fluoroscopy , Gastrointestinal Tract , Diagnostic Imaging , Humans , Male , Mesenteric Arteries , Diagnostic Imaging , Pneumonia, Aspiration , Diagnostic Imaging , Radiography, Abdominal , Superior Mesenteric Artery Syndrome , Diagnostic Imaging , Syndrome , Tomography, X-Ray Computed , Vomiting , Diagnostic Imaging
14.
Article in English | WPRIM | ID: wpr-132490

ABSTRACT

Wheat-dependent exercise-induced anaphylaxis (WDEIA) usually occurs 1 to 4 hours after wheat ingestion and the pathophysiology of WDEIA remains unknown. It is recommended that WDEIA patients refrain from exercise for 4 to 6 hours after wheat ingestion. We report a case of a 51-year-old man who experienced 5 anaphylaxis attacks; two of which occurred 10 to 24 hours after wheat ingestion and exercise. He has a history of chronic gastroenteritis that responds well to antihistamine drugs but not proton pump inhibitors (PPIs) and prokinetic agents. Abdominal CT results implied the possibility of superior mesenteric artery syndrome. We suggest that WDEIA occurs 6 hours after wheat ingestion in cases compounded by obstructive gastrointestinal diseases.


Subject(s)
Anaphylaxis , Eating , Gastroenteritis , Gastrointestinal Diseases , Humans , Middle Aged , Proton Pump Inhibitors , Superior Mesenteric Artery Syndrome , Tomography, X-Ray Computed , Triticum
15.
Article in English | WPRIM | ID: wpr-132487

ABSTRACT

Wheat-dependent exercise-induced anaphylaxis (WDEIA) usually occurs 1 to 4 hours after wheat ingestion and the pathophysiology of WDEIA remains unknown. It is recommended that WDEIA patients refrain from exercise for 4 to 6 hours after wheat ingestion. We report a case of a 51-year-old man who experienced 5 anaphylaxis attacks; two of which occurred 10 to 24 hours after wheat ingestion and exercise. He has a history of chronic gastroenteritis that responds well to antihistamine drugs but not proton pump inhibitors (PPIs) and prokinetic agents. Abdominal CT results implied the possibility of superior mesenteric artery syndrome. We suggest that WDEIA occurs 6 hours after wheat ingestion in cases compounded by obstructive gastrointestinal diseases.


Subject(s)
Anaphylaxis , Eating , Gastroenteritis , Gastrointestinal Diseases , Humans , Middle Aged , Proton Pump Inhibitors , Superior Mesenteric Artery Syndrome , Tomography, X-Ray Computed , Triticum
16.
Article in Korean | WPRIM | ID: wpr-75283

ABSTRACT

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder that causes progressive muscular weakness, severe weight loss, and ultimately death. Gastrostomy or nasogastric tube is beneficial for ALS patients with severe weight loss and dysphagia. However, the development of superior mesenteric artery (SMA) syndrome in ALS patients when the enteral feeding time is delayed is rarely reported. We report herein the first case of SMA syndrome in a Korean ALS patient who showed improvement after percutaneous endoscopic gastrojejunostomy(PEGJ).


Subject(s)
Amyotrophic Lateral Sclerosis , Deglutition Disorders , Enteral Nutrition , Gastric Bypass , Gastrostomy , Humans , Mesenteric Artery, Superior , Muscle Weakness , Neurodegenerative Diseases , Superior Mesenteric Artery Syndrome , Weight Loss
17.
The Ewha Medical Journal ; : 141-145, 2014.
Article in English | WPRIM | ID: wpr-80974

ABSTRACT

Gastric emphysema is caused by a mucosal disruption of stomach, which is leading to the dissection of air into the wall. A 24-year-old man admitted to our hospital with vomiting, abdominal distension, and pain. Abdominal computed tomography showed severe gastric distension, air within the gastric wall, and a compressed third segment of the duodenum by superior mesenteric artery (SMA). The upper endoscopy revealed multiple geographic ulcers in the gastric body and marked dilatation of the second segment of duodenum and a collapsed third segment. Based on these findings and his symptoms, the patient was diagnosed as having gastric emphysema related with SMA syndrome. He improved after the nasogastric decompression, jejunal feeding and administration of antibiotics. We report a rare case of gastric emphysema related with SMA syndrome. He was managed successfully with medical treatment and nutritional support.


Subject(s)
Anti-Bacterial Agents , Decompression , Dilatation , Duodenum , Emphysema , Endoscopy , Gastric Dilatation , Humans , Mesenteric Artery, Superior , Nutritional Support , Stomach , Superior Mesenteric Artery Syndrome , Ulcer , Vomiting , Young Adult
18.
Article in Chinese | WPRIM | ID: wpr-254379

ABSTRACT

<p><b>OBJECTIVE</b>To determine the incidence and risk factors associated to with refractory constipation patients complicated with superior mesenteric artery syndrome (SMAS), and to observe the role of nutritional support in its treatment.</p><p><b>METHODS</b>A prospective nested case-control study was conducted from a constipation cohort(n=973) to assess the incidence and risk factors of SMAS. Pitents with SMAS were matched to controls with a ratio of 1:4 by age and gender. Cases developed SMAS in long-term follow-up(n=26) and controls did not(n=104). Nutritional support was used in 26 patients with SMAS. The efficacy of nutritional support was evaluated by retrospective analysis.</p><p><b>RESULTS</b>The incidence of SMAS in this cohort of patients was 2.7%. Multivariate logistic analysis revealed BMI≤18 kg/m(2) (OR=2.89, 95%CI:1.14-7.31) and prolonged colon transit time(OR=3.57, 95%CI:1.36-9.35) were independent risk factors of SMAS in patients with refractory constipation. A total of 22 patients recovered after treatment of nutritional support. The successful rate of conservative treatment was 84.6%. The clinical symptoms, gastrointestinal quality of life index, Wexner constipation score and nutritional status were all significantly improved after treatment.</p><p><b>CONCLUSION</b>A BMI of less than 18 kg/m(2) and prolonged colon transit time are independent risk factors in refractory constipation patients complicated with SMAS. Nutrition support should be carried out according to illness condition and nutritional status, and combined with theatment of constipation simultaneously.</p>


Subject(s)
Case-Control Studies , Constipation , Humans , Incidence , Nutritional Support , Prospective Studies , Quality of Life , Retrospective Studies , Risk Factors , Superior Mesenteric Artery Syndrome , Therapeutics
19.
Article in English | WPRIM | ID: wpr-112124

ABSTRACT

Superior mesenteric artery (SMA) syndrome is a rare disorder characterized by extrinsic compression of the third portion of the duodenum between the superior mesenteric artery and aorta, resulting in intermittent obstruction, thereby resulting in proximal duodenal and stomach dilatation. Although the most characteristic symptoms are postprandial epigastric pain, fullness, voluminous vomiting, and eructation, severe symptoms including acute massive gastric dilatation to the extent of surgical abdomen was rarely reported. We report a case of SMA syndrome in a 24-year-old patient with an eating disorder. CT and an upper gastointestinal contrast series revealed massive gastric dilatation which induced vascular compressions. Endoscopy showed deep extensive ulcerations of the whole stomach with duodenal necrosis and ischemia, which prompted immediate surgical laparotomy, but no remarkable intra-abdominal peritonitis evidence was noted. We treated the patient conservatively and the patient recovered from all the symptoms.


Subject(s)
Abdomen , Aorta , Duodenum , Feeding and Eating Disorders , Endoscopy , Eructation , Gastric Dilatation , Humans , Ischemia , Laparotomy , Mesenteric Artery, Superior , Necrosis , Peritonitis , Stomach , Superior Mesenteric Artery Syndrome , Ulcer , Vomiting , Young Adult
20.
Arab Journal of Gastroenterology. 2014; 15 (1): 40-41
in English | IMEMR | ID: emr-168640

ABSTRACT

Rosai-Dorfman disease is a rare histiocytic proliferative disorder with a distinctive microscopic appearance. Patients usually present with nonspecific symptoms and massive cervical lymphadenopathy. Exclusive involvement of intra-abdominal lymph nodes is unusual and presentation mimicking Wilkie's syndrome due to compression of the third part of the duodenum by enlarged retroduodenal lymph nodes is rare. This entity should be included in the differential diagnosis with infectious, granulomatous and malignant causes of intra-abdominal lymphadenopathy. We highlight an uncommon presentation and discuss the challenges in the diagnosis and management of Rosai-Dorfman disease


Subject(s)
Humans , Male , Histiocytosis/genetics , Superior Mesenteric Artery Syndrome/etiology , Lymphatic Diseases , Tomography, X-Ray Computed/statistics & numerical data , Biopsy/methods
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