Cohen L B, Field S P, Sachar D B
J Clin Gastroenterol. 1985 Apr;7(2):113-6. doi: 10.1097/00004836-198504000-00002.
Intestinal obstruction of the duodenum by entrapment between the aorta and the superior mesenteric artery (SMA) is an uncommon cause of megaduodenum. Despite many case reports, acceptance of the SMA syndrome as a clinical entity has been controversial on account of its confusion with other causes of megaduodenum. We therefore report a case of SMA syndrome which sharply exemplifies its clinical and anatomic features. The clinical findings are proximal duodenal obstruction with an abrupt cutoff and active peristalsis. The anatomic features of this entity are a narrow angle between the aorta and the SMA, together with high fixation of the duodenum by the ligament of Treitz and/or an anomalous SMA crossing directly over the aorta at its intersection with the duodenum. The SMA syndrome may occur as an acute self-limited event due to a reversible precipitating factor, or as a chronic recurring disorder. The acute form subsides with correction of the specific initiating factor; the chronic form responds favorably to simple surgical mobilization of the duodenum.
十二指肠被主动脉和肠系膜上动脉（SMA）夹闭导致的肠梗阻是巨十二指肠的罕见病因。尽管有许多病例报告，但由于SMA综合征与其他巨十二指肠病因容易混淆，将其作为一种临床实体接受一直存在争议。因此，我们报告一例SMA综合征病例，该病例清晰地展现了其临床和解剖特征。临床发现为近端十二指肠梗阻，梗阻突然且蠕动活跃。该病症的解剖特征是主动脉和SMA之间夹角狭窄，同时十二指肠被Treitz韧带高度固定和/或SMA在与十二指肠交叉处直接越过主动脉。SMA综合征可能因可逆的诱发因素而作为急性自限性事件发生，也可能作为慢性复发性疾病出现。急性形式通过纠正特定的起始因素而缓解；慢性形式对十二指肠的简单手术松解反应良好。
