Panda Nilanjan, Das Ruchira, Gumta Manas, Karmakar Madan, Nandi Mintu Mohan
Department of Surgery, Bankura Sammilani Medical College and Hospital, wbmes Gobindonagar, Bankura, West Bengal, India.
Acta Gastroenterol Latinoam. 2013 Sep;43(3):240-7.
The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and abrupt weight loss. Usually seen in tall individual with low bod mass index (BMI), the weight loss may be primary or secondary to a systemic disease or to the syndrome itself Compression of the duodenum between the abdominal aorta and the superior mesenteric artery due to loss of the duodenal pad of fat causes the obstruction. Early recognition prevent complications. Imaging and endoscopy is diagnostic. Aorto-mesenteric angle and SMA aorta distance is lower than 22 degree and eight millimeter respectively. If nutritional support fails, surgery is required (e.g. guodeno-jejunostomy). Studies to determine the optimal methods of diagnosis and treatment, especially in a suburban hospitals with limited expertise are essential.
We retrospectively evaluated 8 cases presented over three years. Six (75%) patients were males, age ranged from 19 to 70 years and weight from 40 to 55 kg. The mean BMI was 18.7 kg/ m2 (range 16.42 to 25.11 kg/m2). Mean weight loss before diagnosis was 9.88 kg (range 6 to 12 kg). Symptoms developed between 8 to 180 days (median 12 days). Commonest presentation was epigastric pain, vomiting and nausea. Four patients had pre-morbid conditions and the syndrome was idiopathic in the other 4. Median aorto-mesentric angle was 16.5 degree and SMA-aorta distance was 5.15 mm. Four patients required operation. The rest improved on conservative treatment.
Early recognition, institution of the appropriate conservative measures and timely selection of a definite surgical method are critical to prevent severe complications and death.
肠系膜上动脉综合征是一种罕见疾病，表现为上消化道梗阻和体重骤减。该综合征常见于体重指数（BMI）较低的高个子个体，体重减轻可能是原发性的，也可能继发于全身性疾病或综合征本身。十二指肠脂肪垫缺失导致十二指肠被腹主动脉和肠系膜上动脉压迫，从而引起梗阻。早期识别可预防并发症。影像学检查和内镜检查具有诊断价值。腹主动脉与肠系膜上动脉夹角及肠系膜上动脉与腹主动脉距离分别低于22度和8毫米。若营养支持无效，则需进行手术（如十二指肠空肠吻合术）。开展研究以确定最佳诊断和治疗方法至关重要，尤其是在专业知识有限的郊区医院。
我们回顾性评估了三年间收治的8例患者。6例（75%）为男性，年龄在19至70岁之间，体重40至55千克。平均BMI为18.7千克/平方米（范围为16.42至25.11千克/平方米）。诊断前平均体重减轻9.88千克（范围为6至12千克）。症状出现于8至180天之间（中位数为12天）。最常见的表现为上腹部疼痛、呕吐和恶心。4例患者有基础疾病，另4例综合征为特发性。腹主动脉与肠系膜上动脉夹角中位数为16.5度，肠系膜上动脉与腹主动脉距离为5.15毫米。4例患者需要手术治疗。其余患者经保守治疗后病情改善。
早期识别、采取适当的保守措施以及及时选择明确的手术方法对于预防严重并发症和死亡至关重要。
