增加体重以治疗肠系膜上动脉综合征。
Increase body weight to treat superior mesenteric artery syndrome.
作者信息
Albano Miguel Nico, Costa Almeida Carlos, Louro João Mendes, Martinez Guillermo
机构信息
Centro Hospitalar de Coimbra, Cirurgia C, Coimbra, Portugal.
CHUC, HG, Coimbra, Coimbra, Portugal.
出版信息
BMJ Case Rep. 2017 Jun 2;2017:bcr-2017-219378. doi: 10.1136/bcr-2017-219378.
INTRODUCTION
Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction resulting from vascular compression of the third part of the duodenum in the angle between the abdominal aorta and SMA.
CASE PRESENTATION
A 19-year-old woman with anorexia nervosa with upper gastrointestinal obstruction symptoms resorted to the emergency department. A diagnosis of SMA syndrome was made. Symptoms were solved with conservative treatment aimed at increase body weight.
DISCUSSION
SMA syndrome is most commonly associated with debilitating illnesses. Patients present with acute or insidious upper gastrointestinal obstruction symptoms. Aortomesenteric artery angle of ≤25° is the most sensitive measure of diagnosis. Advances in both enteral and parenteral nutrition led to a shift towards conservative treatment.
CONCLUSIONS
Low threshold of suspicion is important to make a timely diagnosis and treatment. A conservative treatment aimed at increasing body weight is the first-line approach, leaving surgical intervention for failure cases.
引言
肠系膜上动脉（SMA）综合征是十二指肠梗阻的罕见原因，由腹主动脉和肠系膜上动脉夹角处对十二指肠第三部的血管压迫所致。
病例介绍
一名19岁患有神经性厌食症且有上消化道梗阻症状的女性前往急诊科就诊。诊断为SMA综合征。通过旨在增加体重的保守治疗，症状得到缓解。
讨论
SMA综合征最常与使人衰弱的疾病相关。患者表现为急性或隐匿性上消化道梗阻症状。腹主动脉肠系膜动脉夹角≤25°是最敏感的诊断指标。肠内和肠外营养的进展导致治疗倾向于保守治疗。
结论
保持较低的怀疑阈值对于及时诊断和治疗很重要。旨在增加体重的保守治疗是一线治疗方法，手术干预仅用于治疗失败的病例。
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