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肠系膜上动脉综合征:诊断与管理

Superior Mesenteric Artery Syndrome: Diagnosis and Management.

作者信息

Kumar R, Jaiswal G, Bhargava A, Kundu J

机构信息

Department of Radiodiagnosis, Geetanjali Medical College and Hospital, Geetanjali University, Udaipur, India.

Department of Prosthodontics, Geetanjali Dental and Research Institute, Geetanjali University, Udaipur, India.

出版信息

Kathmandu Univ Med J (KUMJ). 2016;14(55):288-291.

Abstract

Superior mesenteric artery syndrome is a life-threatening rare acquired upper gastrointestinal disorder due to mechanical compression of third part of duodenum by the acute angulation of Superior mesenteric artery, leading to obstruction. Acute loss of intervening mesenteric fat as a result of a variety of debilitating conditions is believed to be the etiologic factor causing the reduced aortomesenteric angle. Abdominal CT angiography showed the dilatation of second part of duodenum and vascular compression of the proximal third part of the duodenum between the aorta and superior mesenteric artery. We report a case of 15 year old young boy who presented with recurrent postprandial pain in the epigastric region, accompanied by epigastric fullness, nausea, postprandial bilious vomiting and weight loss. When conservative measures were ineffective, laparoscopic retrocolic duodenojejunostomy, side to side anastomosis, was performed in the patient to relieve the obstruction. This case report is unusual as it is concerned with the description of a rare disease entity and its radiological appearances for early preoperative diagnosis, better understanding and management of the disease are discussed in the pertinent light of literature.

摘要

肠系膜上动脉综合征是一种危及生命的罕见获得性上消化道疾病,由于肠系膜上动脉急性成角对十二指肠第三部造成机械性压迫,导致梗阻。各种衰弱性疾病导致肠系膜间脂肪急性减少被认为是导致腹主动脉肠系膜角减小的病因。腹部CT血管造影显示十二指肠第二部扩张以及十二指肠近端第三部在主动脉和肠系膜上动脉之间受到血管压迫。我们报告一例15岁男孩,表现为上腹部反复餐后疼痛,伴有上腹部饱胀、恶心、餐后胆汁性呕吐和体重减轻。当保守措施无效时,对该患者实施了腹腔镜结肠后十二指肠空肠吻合术(侧侧吻合)以缓解梗阻。本病例报告不同寻常之处在于它涉及一种罕见疾病实体的描述及其影像学表现,针对早期术前诊断进行了探讨,并结合文献对该疾病的更好理解和管理进行了讨论。

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