Cicero Giuseppe, D'Angelo Tommaso, Bottari Antonio, Costantino Giuseppe, Visalli Carmela, Racchiusa Sergio, Marino Maria Adele, Cavallaro Marco, Frosina Luciano, Blandino Alfredo, Mazziotti Silvio
Section of Radiological Sciences - Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Messina, Italy.
Clinical Unit for Chronic Bowel Disorders - Department of Clinical and Experimental Medicine, University of Messina, Policlinico "G. Martino", Messina, Italy.
Am J Case Rep. 2018 Apr 12;19:431-437. doi: 10.12659/ajcr.908273.
BACKGROUND Superior mesenteric artery syndrome is caused by vascular compression of the third portion of the duodenum between the aorta and the superior mesenteric artery. It may occur with acute or chronic symptomatology, such as vomiting or postprandial abdominal pain, and it is usually caused by a lack of mesenteric fat pad under conditions of severe weight loss. Crohn's disease can be one of them. CASE REPORT We report 2 cases of Crohn's disease patients with clinical suspicion of jejunal stricture who underwent MR-enterography with a novel approach. In fact, the examinations were performed including prone position of the patients inside the scanner, drinking of contrast medium during the examination, and prompt acquisition of fluoroscopic sequences. Both the exams showed an abrupt termination of the duodenum on its third portion and a decreased aortomesenteric distance, allowing the diagnosis of superior mesenteric artery syndrome. CONCLUSIONS A correlation between Crohn's disease and superior mesenteric artery syndrome has never before been reported in the literature. The present study provides some practical steps that may be useful in order to improve MRE standard protocol in recognizing this condition while evaluating Crohn's disease bowel lesions.
背景 肠系膜上动脉综合征是由十二指肠第三部在主动脉和肠系膜上动脉之间受到血管压迫所致。它可出现急性或慢性症状，如呕吐或餐后腹痛，通常是在严重体重减轻的情况下由于肠系膜脂肪垫缺乏引起。克罗恩病可能是其中原因之一。病例报告 我们报告2例临床怀疑空肠狭窄的克罗恩病患者，他们采用一种新方法接受了磁共振小肠造影检查。实际上，检查时让患者在扫描器内取俯卧位，检查期间饮用造影剂，并迅速采集透视序列图像。两项检查均显示十二指肠第三部突然中断，主动脉与肠系膜间距减小，从而确诊为肠系膜上动脉综合征。结论 文献中此前从未报道过克罗恩病与肠系膜上动脉综合征之间的关联。本研究提供了一些实用步骤，可能有助于在评估克罗恩病肠道病变时改进磁共振小肠造影标准方案以识别这种情况。
