一名因神经性厌食症导致肠系膜上动脉综合征的16岁女孩的合理管理面临的独特挑战：病例报告
Unique challenges for appropriate management of a 16-year-old girl with superior mesenteric artery syndrome as a result of anorexia nervosa: a case report.
作者信息
Verhoef Philip A, Rampal Angelika
机构信息
Department of Internal Medicine, University of California, Los Angeles, Le Conte Ave, Los Angeles, CA, USA.
出版信息
J Med Case Rep. 2009 Nov 16;3:127. doi: 10.1186/1752-1947-3-127.
INTRODUCTION
Nausea and vomiting in an adolescent, though common presenting symptoms, often pose a diagnostic and therapeutic challenge to the physician. When the diagnosis involves both medical and psychiatric components, management can be complex, especially in the current healthcare system in the United States. To the best of our knowledge, there have been no previous publications detailing successful management of a patient with anorexia nervosa and superior mesenteric artery syndrome.
CASE PRESENTATION
We report the case of a 16-year-old Caucasian girl who presented to our emergency department with nausea, abdominal pain, diminished appetite and vomiting. Her history and examination were notable for a 15 kg weight loss and diffuse abdominal tenderness. A barium swallow X-ray with small bowel follow-through and computed tomography scan demonstrated remarkable duodenal narrowing between the superior mesenteric artery and the aorta, consistent with superior mesenteric artery syndrome. Initial management focused on relieving the obstruction and supporting the nutritional needs of the patient. Further history confirmed a diagnosis of anorexia nervosa, requiring intensive psychiatric and medical management, and necessitating a multifaceted approach to patient care involving social work, multiple primary care physicians and subspecialists, insurance company representatives, and the patient's immediate family.
CONCLUSION
This case illustrates important points regarding the pathogenesis of superior mesenteric artery syndrome in the setting of anorexia, and it highlights the complexities that arise when managing an adolescent with both medical and psychiatric needs, as well as outlining a viable solution. While superior mesenteric artery syndrome is an uncommon cause of small bowel obstruction, the general pediatrician and child psychiatrist should be aware of this complication of anorexia nervosa.
引言
青少年恶心和呕吐虽是常见症状，但常给医生带来诊断和治疗挑战。当诊断涉及医学和精神科因素时，管理可能很复杂，在美国当前的医疗体系中尤其如此。据我们所知，此前尚无详细介绍成功治疗神经性厌食症合并肠系膜上动脉综合征患者的文献。
病例介绍
我们报告一例16岁白人女孩，她因恶心、腹痛、食欲减退和呕吐就诊于我院急诊科。其病史和检查显示体重减轻15千克，全腹压痛。上消化道钡餐造影加小肠造影及计算机断层扫描显示，肠系膜上动脉与主动脉之间十二指肠明显狭窄，符合肠系膜上动脉综合征。初始治疗重点是解除梗阻并满足患者的营养需求。进一步询问病史确诊为神经性厌食症，需要强化精神科和医学管理，需要采取多方面方法进行患者护理，涉及社会工作者、多名初级保健医生和专科医生、保险公司代表以及患者直系亲属。
结论
本病例说明了厌食症背景下肠系膜上动脉综合征发病机制的要点，凸显了治疗有医学和精神科需求的青少年时出现的复杂性，并概述了一个可行的解决方案。虽然肠系膜上动脉综合征是小肠梗阻的罕见原因，但普通儿科医生和儿童精神科医生应了解神经性厌食症的这一并发症。
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