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肠系膜上动脉综合征导致的坏死性巨胃。

Necrotic mega-stomach from superior mesenteric artery syndrome.

作者信息

Tse Andrew, Phan Natalie, Ayoubi Salah, Fenton-Lee Douglas

机构信息

Department of Surgery, St Vincent's Hospital Sydney, 390 Victoria St, Darlinghurst, Sydney, New South Wales, 2010, Australia.

St Vincent's Clinical School, University of New South Wales, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.

出版信息

J Surg Case Rep. 2024 Jul 20;2024(7):rjae463. doi: 10.1093/jscr/rjae463. eCollection 2024 Jul.

DOI:10.1093/jscr/rjae463
PMID:39036767
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11260180/
Abstract

Superior mesenteric artery (SMA) syndrome is a rare cause of proximal bowel obstruction due to duodenal compression by the SMA. The morbidity and mortality associated with delayed diagnosis and its complications make it an important differential cause for bowel obstruction. We report a case of mega-stomach secondary to SMA syndrome requiring total gastrectomy. An 18-year-old male presented with vomiting, abdominal pain and shock after a buffet. Computed tomography (CT) imaging revealed a grossly distended stomach (113 × 187 × 350mm) and a transition point at the third part of the duodenum, along with pneumatosis and portal venous gas. Emergency gastroscopy showed blood and necrotic mucosa. Laparotomy confirmed full thickness necrosis and the patient underwent a total gastrectomy with Roux-en-Y reconstruction. Postoperatively, he had a brief intensive care stay and recovered without complications. This case underscores the importance of considering SMA syndrome during presentations of acute gastric dilatation.

摘要

肠系膜上动脉（SMA）综合征是一种由SMA压迫十二指肠导致近端肠梗阻的罕见病因。与诊断延误及其并发症相关的发病率和死亡率使其成为肠梗阻的一个重要鉴别病因。我们报告一例继发于SMA综合征的巨胃症病例，该病例需要行全胃切除术。一名18岁男性在自助餐进食后出现呕吐、腹痛和休克。计算机断层扫描（CT）成像显示胃明显扩张（113×187×350mm），十二指肠第三段有一个移行点，伴有肠壁积气和门静脉积气。急诊胃镜检查显示有血液和坏死黏膜。剖腹探查证实为全层坏死，患者接受了全胃切除术并进行了Roux-en-Y重建。术后，他在重症监护室短暂停留，康复过程中未出现并发症。该病例强调了在急性胃扩张表现时考虑SMA综合征的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d04f/11260180/7d7650981b66/rjae463f10.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d04f/11260180/a2afed4d54e2/rjae463f9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d04f/11260180/7d7650981b66/rjae463f10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d04f/11260180/6f787be8ba6e/rjae463f1.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d04f/11260180/c840fa2d3c58/rjae463f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d04f/11260180/39583315062d/rjae463f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d04f/11260180/9b5927640dc8/rjae463f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d04f/11260180/6f3a9ddbf382/rjae463f7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d04f/11260180/f9593056b778/rjae463f8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d04f/11260180/a2afed4d54e2/rjae463f9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d04f/11260180/7d7650981b66/rjae463f10.jpg

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本文引用的文献

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Acute gastric dilatation with superior mesenteric artery syndrome after binge eating.暴饮暴食后并发急性胃扩张伴肠系膜上动脉综合征
Pediatr Int. 2023 Jan-Dec;65(1):e15640. doi: 10.1111/ped.15640.
2
Gastric Pneumatosis and Its Gastrofibroscopic Findings in Life-Threatening Superior Mesenteric Artery Syndrome Complicated by Anorexia Nervosa in a Child.儿童神经性厌食症并发危及生命的肠系膜上动脉综合征时的胃壁积气及其胃镜检查结果
Pediatr Gastroenterol Hepatol Nutr. 2023 Sep;26(5):284-289. doi: 10.5223/pghn.2023.26.5.284. Epub 2023 Sep 1.
3
Massive Gastric Dilatation and Multi-Organ Ischemia Due to Superior Mesenteric Artery Syndrome: A Rare Case Report.
巨胃扩张并肠系膜上动脉综合征致多器官缺血：罕见病例报告。
Am J Case Rep. 2023 Sep 14;24:e940910. doi: 10.12659/AJCR.940910.
4
Superior mesenteric artery syndrome with acute gastric dilatation caused by binge eating in an adolescent.青少年暴饮暴食致肠系膜上动脉综合征伴急性胃扩张
Korean J Intern Med. 2022 Jul;38(4):572-573. doi: 10.3904/kjim.2022.344. Epub 2023 Jun 26.
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Total gastric necrosis following massive gastric dilatation due to superior mesenteric artery syndrome.由于肠系膜上动脉综合征导致的大量胃扩张后全胃坏死。
Asian J Surg. 2023 Jun;46(6):2363-2364. doi: 10.1016/j.asjsur.2022.12.008. Epub 2022 Dec 21.
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A case of gastric ischemia caused by massive gastric dilatation due to superior mesenteric artery syndrome.肠系膜上动脉综合征致胃大量扩张致胃缺血 1 例。
Clin J Gastroenterol. 2020 Dec;13(6):1066-1069. doi: 10.1007/s12328-020-01192-7. Epub 2020 Jul 27.
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