Kaur Amarjit, Pawar Naveen Chandrashekhar, Singla Sonam, Mohi Jaswinder Kaur, Sharma Shivani
Professor, Department of Radiodiagnosis, GMC Patiala, Punjab, India .
Junior Resident, Department of Radiodiagnosis, GMC Patiala, Punjab, India .
J Clin Diagn Res. 2016 Jun;10(6):TD03-5. doi: 10.7860/JCDR/2016/19699.7932. Epub 2016 Jun 1.
Superior Mesenteric Artery (SMA) syndrome is one of the rare cause of proximal small bowel obstruction wherein, the third part of the duodenum is compressed between the SMA at its origin and abdominal aorta due to decreased angulations in these two vessels. This decreased angulation exerts a compression effect on third part of the duodenum, resulting in duodenal obstruction which may be complete or partial. There are number of causes which can lead to this entity and will be discussed briefly. Here we report imaging findings of such a rare cause of proximal small bowel obstruction in a young male patient who presented to the emergency surgical department with non specific symptoms of pain abdomen and abdominal fullness. Patient was evaluated under the standard protocol in management of abdominal pain. General physical examination, erect and supine radiograph were taken. On barium meal follow-through examination, there was paucity of contrast agent distal to the second part of duodenum with proximal dilation of stomach, first and second part of duodenum which raised us the possibility of SMA syndrome. Reconstructed CECT abdomen confirmed the decreased angulation between SMA and abdominal aorta and diagnosed it as SMA syndrome. Findings were correlated on duodenojejunostomy anastomotic surgical procedure. Diagnosing and reporting such a case of SMA syndrome is of utmost importance because the clinical presentation being non-specific pertaining to small bowel obstruction which may pose a diagnostic difficulty to the surgeon and with the further delay in diagnosis, patients may end up with chronic symptoms and complications of the disease, repeated hospital visits and electrolyte abnormalities.
肠系膜上动脉（SMA）综合征是近端小肠梗阻的罕见原因之一，在该综合征中，十二指肠第三部在肠系膜上动脉起始处与腹主动脉之间受到压迫，原因是这两根血管之间的夹角减小。夹角减小对十二指肠第三部产生压迫作用，导致十二指肠梗阻，可能是完全性或部分性梗阻。有多种原因可导致该病症，将简要讨论。在此，我们报告一名年轻男性患者近端小肠梗阻这一罕见病因的影像学表现，该患者因腹痛和腹部胀满等非特异性症状就诊于急诊外科。患者按照腹痛管理的标准方案进行评估。进行了全身体格检查，并拍摄了立位和仰卧位腹部X线片。在钡餐造影检查中，十二指肠第二部远端造影剂减少，胃、十二指肠第一部和第二部近端扩张，这使我们怀疑是肠系膜上动脉综合征。腹部CT血管造影重建证实肠系膜上动脉与腹主动脉之间夹角减小，并诊断为肠系膜上动脉综合征。这些发现与十二指肠空肠吻合术的手术过程相关。诊断并报告这样一例肠系膜上动脉综合征病例至关重要，因为其临床表现与小肠梗阻相关且不具有特异性，这可能给外科医生带来诊断困难，而且随着诊断的进一步延迟，患者最终可能出现该疾病的慢性症状和并发症、反复住院以及电解质异常。
