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肠系膜上动脉综合征误诊且先于药物性胃炎:一种具有误导性特征的罕见诊断。

Superior mesenteric artery syndrome misdiagnosed and preceded by -induced gastritis: a rare diagnosis with misleading features.

作者信息

Ismail Sawsan, Hasan Mohammad, Aljasem Muhamad, Darkaznli Mohamad Ismaeel, Habib Alice, Deeb Hala, Alkhalil Batool, Sheikh Mohamad Lalsh, Khalil Aleen, Kattash Shatha, Arja Joudi, Haydar Khalil

机构信息

Faculty of Medicine, Al-Andalus University for Medical Sciences, Tartous, Syria.

出版信息

Ann Med Surg (Lond). 2024 May 6;86(12):7322-7324. doi: 10.1097/MS9.0000000000002136. eCollection 2024 Dec.

Abstract

INTRODUCTION AND IMPORTANCE

Superior mesenteric artery (SMA) syndrome is a rare morbid vascular disorder that is defined as the decrease in the aortomesenteric angle and the compression of the third part of the duodenum. This disorder mainly affects young adult females, and severe weight loss represents a leading predisposing factor.

CASE PRESENTATION

The authors report the case of a 19-year-old male who was admitted to our hospital with a 3-month history of epigastric pain, nausea, and weight loss. Two months earlier, the patient was diagnosed with -induced gastritis. Nevertheless, with complaints of severe headache and epigastric pain, the patient was admitted to our hospital for further investigations. Computed tomography (CT) scan with intravenous contrast injection was performed, and interestingly, the aortomesenteric angle was 19° accompanied by a compression of the third part of the duodenum, and a mild gastric dilatation. Accordingly, the diagnosis was confirmed as superior mesenteric artery syndrome.

CLINICAL DISCUSSION

In the authors' case, the non-specific clinical symptoms correlated with histopathological examinations led to the initial diagnosis of -induced gastritis. Surprisingly, the lack of improvements led to performing CT scan, which confirmed the diagnosis of SMA syndrome. Subsequently, HP gastritis played a significant role in misleading and delaying the diagnosis.

CONCLUSION

The authors report the first case report from Syria of s superior mesenteric artery syndrome that was misdiagnosed and preceded by HP-induced gastritis, highlighting the crucial role of detailed clinical and radiological examinations in the diagnosis of challenging cases with morbid complications.

摘要

引言与重要性

肠系膜上动脉(SMA)综合征是一种罕见的病态血管疾病,定义为腹主动脉与肠系膜上动脉夹角减小以及十二指肠第三部受压。这种疾病主要影响年轻成年女性,严重体重减轻是主要的诱发因素。

病例报告

作者报告了一例19岁男性患者,因上腹部疼痛、恶心和体重减轻3个月入院。两个月前,该患者被诊断为幽门螺杆菌(HP)感染性胃炎。然而,由于患者主诉严重头痛和上腹部疼痛,遂入院进一步检查。进行了静脉注射造影剂的计算机断层扫描(CT),有趣的是,腹主动脉与肠系膜上动脉夹角为19°,伴有十二指肠第三部受压和轻度胃扩张。因此,确诊为肠系膜上动脉综合征。

临床讨论

在作者的病例中,与组织病理学检查相关的非特异性临床症状导致最初诊断为HP感染性胃炎。令人惊讶的是,症状未改善促使进行CT扫描,从而确诊为SMA综合征。随后发现,HP胃炎在误导和延误诊断方面起了重要作用。

结论

作者报告了叙利亚首例肠系膜上动脉综合征病例,该病例被误诊且先有HP感染性胃炎,强调了详细的临床和影像学检查在诊断伴有病态并发症的疑难病例中的关键作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b907/11623854/eae5cf471b8f/ms9-86-7322-g001.jpg

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