Ballantyne G H, Graham S M, Hammers L, Modlin I M
Dis Colon Rectum. 1987 Jun;30(6):472-4. doi: 10.1007/BF02556500.
This is the first case report of the superior mesenteric artery syndrome developing in a patient following total proctocolectomy and ileal J-pouch anal anastomosis. In addition, this is the first demonstration of this syndrome using abdominal CT scan. A 22-year-old veteran underwent total proctocolectomy for left-sided ulcerative colitis because of failure of medical therapy. At operation an ileal J-pouch anal anastomosis was constructed. Following operation, the patient developed an intestinal obstruction. Abdominal CT scan demonstrated scant retroperitoneal fatty tissue, massive dilatation of the duodenum proximal to the midline, and tapered narrowing of the duodenum between the superior mesenteric artery and aorta. These findings indicated superior mesenteric artery syndrome: arteriomesenteric obstruction of the duodenum. Based on the experience of this case, the authors believe that compression of the duodenum by the superior mesenteric artery may be a common but unsuspected cause of prolonged postoperative ileus or early postoperative obstruction following ileal pouch anal anastomosis.
这是首例在全直肠结肠切除及回肠J形贮袋肛管吻合术后发生肠系膜上动脉综合征的病例报告。此外，这也是首次通过腹部CT扫描证实该综合征。一名22岁的退伍军人因内科治疗无效，接受了左侧溃疡性结肠炎的全直肠结肠切除术。术中构建了回肠J形贮袋肛管吻合术。术后，患者出现肠梗阻。腹部CT扫描显示腹膜后脂肪组织稀少，十二指肠在中线近端大量扩张，在肠系膜上动脉和主动脉之间的十二指肠呈锥形狭窄。这些发现提示肠系膜上动脉综合征：十二指肠的动脉肠系膜梗阻。基于该病例的经验，作者认为肠系膜上动脉对十二指肠的压迫可能是回肠贮袋肛管吻合术后长时间肠梗阻或早期术后梗阻的常见但未被怀疑的原因。
