Kitaura K, Harima K
Department of Internal Medicine, Suzuran Hospital, Suzurandai-Nishimachi, Kita-ku, Kobe-city, Hyogo, Japan.
Clin Nephrol. 2009 Feb;71(2):228-30. doi: 10.5414/cnp71228.
Superior mesenteric artery (SMA) syndrome is defined as trapping of the third portion of the duodenum between the SMA and the aorta. In this case, vascular calcification associated with dialysis might have contributed to the onset of SMA syndrome.
The patient was a 74-year-old woman who had been receiving maintenance hemodialysis. She developed sudden onset of severe recurrent vomiting during admission for pseudo-gout. CT of the abdomen revealed duodenal obstruction with an abrupt cutoff in the third portion of the duodenum, and dilatation of the first and second portions of the duodenum. The aortomesenteric angle was significantly sharp. In addition, severe vascular calcification was revealed in the SMA and aorta. The initial treatment was decompression of the obstruction by a nasogastric tube and parenteral nutrition for the management of fluid and electrolyte imbalance. She recovered with only conservative treatment.
Vascular calcification of the SMA and aorta might have contributed to compression of the third portion of the duodenum. Vascular calcification associated with dialysis could be a factor in SMA syndrome.
肠系膜上动脉（SMA）综合征定义为十二指肠第三部被SMA和主动脉夹住。在这种情况下，与透析相关的血管钙化可能促使了SMA综合征的发病。
患者为一名74岁接受维持性血液透析的女性。她因假性痛风入院期间突然出现严重反复呕吐。腹部CT显示十二指肠梗阻，十二指肠第三部突然截断，十二指肠第一部和第二部扩张。腹主动脉肠系膜角明显变锐。此外，SMA和主动脉有严重的血管钙化。初始治疗是通过鼻胃管解除梗阻，并给予肠外营养以纠正液体和电解质失衡。她仅通过保守治疗就康复了。
SMA和主动脉的血管钙化可能导致十二指肠第三部受压。与透析相关的血管钙化可能是SMA综合征的一个因素。
