Asbah Malvina, Shrateh Oadi N, Musleh Asil, Abbadi Khaled, Nofal Mohammed, Tarifi Sulaiman
Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine.
Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
Int J Surg Case Rep. 2023 May;106:108267. doi: 10.1016/j.ijscr.2023.108267. Epub 2023 Apr 26.
Due to a decrease in the aortomesenteric angle, the third section of the duodenum can become acutely or chronically compressed in the superior mesenteric artery syndrome (SMAS).
A 31-year-old male patient complained of one-year-long recurrent postprandial abdominal pain, periumbilical, intermittent, and colicky. The pain increased in severity in the last 4 months and was relieved only with self-induced vomiting and partially with the knee-to-chest position. A CT scan was done and is most consistent with superior mesenteric artery syndrome. The patient was admitted to the operating room and underwent a successful laparoscopic duodenectomy of the third part of duodenum followed by duodenojejunostomy.
When conservative therapy fails, an open duodenojejunostomy is traditionally advised. A less invasive option that has been documented in up to 10 cases is laparoscopic duodenojejunostomy. We discuss the research on this issue and demonstrate our surgical method on one patient.
Even if there has been just a modest amount of weight loss, SMAS should be taken into account whenever a sudden observation of gastrointestinal obstruction symptoms is noted in patients with susceptible conditions such as low body weight.
由于主动脉肠系膜角减小，十二指肠第三段在肠系膜上动脉综合征（SMAS）中可发生急性或慢性受压。
一名31岁男性患者主诉反复餐后腹痛长达一年，疼痛位于脐周，呈间歇性绞痛。在过去4个月中疼痛加剧，仅通过自行催吐可缓解，采用胸膝位可部分缓解。进行了CT扫描，结果最符合肠系膜上动脉综合征。患者被送入手术室，成功接受了十二指肠第三部分的腹腔镜十二指肠切除术，随后进行了十二指肠空肠吻合术。
当保守治疗失败时，传统上建议进行开放性十二指肠空肠吻合术。一种侵入性较小的选择是腹腔镜十二指肠空肠吻合术，已有多达10例的文献记载。我们讨论了关于这个问题的研究，并展示了我们对一名患者的手术方法。
即使体重仅有适度减轻，在体重过低等易感条件的患者中，一旦突然观察到胃肠道梗阻症状，就应考虑到SMAS。
