Raissi B, Taylor B M, Taves D H
Department of Surgery, St. Joseph's Health Centre, University of Western Ontario, London.
Can J Surg. 1996 Oct;39(5):410-6.
Superior mesenteric artery syndrome (SMAS) is a rare condition. The diagnosis is usually made by exclusion. A previously healthy 20-year-old woman who had recurrent SMAS is described. Diagnosis of the condition was difficult. Initially, small-bowel enteroclysis, upper gastrointestinal series and endoscopy, biopsy of gastric and duodenal mucosa, abdominal computed tomography (CT) and ultrasonography were used to make the diagnosis. Abdominal CT suggested pancreatitis causing compressive obstruction of the superior mesenteric artery. Conservative management was helpful at first, but cramping and projectile emesis recurred. Upper gastrointestinal series suggested duodenal distension and a filling defect in the region of the superior mesenteric artery. Repeat endoscopy showed a lateral pulsatile compression in the region of the distal duodenum and SMAS was diagnosed. Medical therapy was not helpful so duodenojejunostomy was carried out. The operation was successful and the patient was symptom-free for 1 year, when the syndrome recurred, with symptoms of periumbilical pain, intermittent episodes of vomiting and loose stools. At reoperation the duodenojejunal anastomosis was found to be displaced to the left of the superior mesenteric artery pedicle causing recurrent obstruction. The duodenojejunostomy was converted to a Roux-en-Y duodenojejunostomy. The patient has since remained well. A MEDLINE search of the literature for the period 1961 to October 1994 revealed that there were no reported cases of a recurrence of SMAS in an otherwise healthy adult patient. In spite of the difficulty in diagnosing this condition, heightened awareness can lead to early diagnosis and avoid unnecessary suffering for the patient.
肠系膜上动脉综合征（SMAS）是一种罕见病症。诊断通常通过排除法做出。本文描述了一名既往健康的20岁复发性SMAS女性患者。该病症的诊断颇具难度。起初，采用小肠灌肠造影、上消化道造影及内镜检查、胃和十二指肠黏膜活检、腹部计算机断层扫描（CT）及超声检查来进行诊断。腹部CT提示胰腺炎导致肠系膜上动脉受压梗阻。起初保守治疗有效，但绞痛和喷射性呕吐复发。上消化道造影提示十二指肠扩张及肠系膜上动脉区域存在充盈缺损。重复内镜检查显示十二指肠远端区域有侧向搏动性压迫，从而确诊为SMAS。药物治疗无效，遂行十二指肠空肠吻合术。手术成功，患者1年内无症状，之后该综合征复发，出现脐周疼痛、间歇性呕吐及腹泻症状。再次手术时发现十二指肠空肠吻合口移位至肠系膜上动脉蒂左侧，导致再次梗阻。将十二指肠空肠吻合术改为Roux-en-Y式十二指肠空肠吻合术。此后患者情况良好。对1961年至1994年10月期间的文献进行MEDLINE检索发现，此前并无关于健康成年患者SMAS复发的报道病例。尽管该病症诊断困难，但提高认识可实现早期诊断，避免患者遭受不必要的痛苦。
