Successful conservative treatment of an isolated inflammatory superior mesenteric artery aneurysm

Inflammatory superior mesenteric artery aneurysm is an extremely rare but life-threatening condition that can result in fatal rupture. Early surgery has been emphasized to prevent aneurysm rupture. We present a case that was successfully managed with conservative treatment. The patient was treated with intravenous methylprednisolone pulse therapy followed by oral prednisolone. Steroid therapy should be considered for unruptured inflammatory superior mesenteric artery aneurysms before surgery.     

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目的 对肠系膜上动脉压迫综合征的病因、诊断及治疗进行分析和探讨。方法 收集1970年1月至2000年8月住院治疗，经X线钡餐检验或手术确认为肠系膜上动脉压迫综合征77例。结果 保守治疗38例，好转31例（81．6％），未愈和未治6例，死亡1例。手术治疗39例，痊愈35例（89．7％），好转4例。结论 肠系膜上动脉压迫综合征的诊断除应具有上腹胀痛、呕吐等典型症状外，主要的确诊手段为X线钡餐造影；治疗上首先采用保守治疗，无效者再行手术治疗。术式选择以采用十二指肠空肠侧侧吻合术效果较为明显（P＜0．01）。     

Laparoscopic treatment of superior mesenteric artery syndrome.

BACKGROUND: Superior mesenteric artery syndrome is caused by compression of the third portion of the duodenum by the superior mesenteric artery. Many disease states predispose one to this condition. METHODS: We present a case report of a young female patient who presented with gastro-duodenal obstruction from superior mesenteric artery syndrome and subsequently underwent surgical treatment with minimally invasive techniques. Pathophysiology of SMA syndrome is reviewed. RESULTS: The cause of superior mesenteric artery syndrome is variable but always results in duodenal obstruction. Surgery is one treatment option that is effective and can be performed laparoscopically. CONCLUSION: Laparoscopic duodenojejunostomy is an acceptable method of treating superior mesenteric artery syndrome.     

Surgical approach to the superior mesenteric artery by the Kocher maneuver: Anatomy study and clinical applications

The Kocher maneuver allows approaching the origin of the superior mesenteric artery. This affords adequate exposure for procedures such as embolectomy or mesenteric arterial reimplantation into the aorta. Because of its simplicity, this technique may be better than the classical interpancreaticoduodenal or splenopancreatic methods. The results of 11 cadaveric dissections and two surgical operations for mesenteric ischemia using this technique are reported.     

Risk factor analysis and treatment outcome of patients with spontaneous isolated celiac axis or superior mesenteric artery dissection

BackgroundSpontaneous isolated mesenteric artery (celiac axis or superior mesenteric artery [SMA]) dissection (IMAD) is a rare clinical entity. The aim of the present study was to examine the patient demographics, comorbidities, clinical and radiologic features, management, and prognosis and to identify the risk factors predictive of symptoms.MethodsWe performed a single-center, retrospective review from November 2005 to November 2021 of prospectively collected data from patients with a diagnosis of IMAD. The clinical data and radiologic images were reviewed, and statistical analysis was performed to compare the symptomatic and asymptomatic groups.ResultsA total of 78 patients were identified. Of the 78 patients, 24 (31%) had had celiac dissections, 51 (65%) had had SMA dissections, and 3 (4%) had had both celiac and SMA dissections. The mean age was 57.7 years (range, 36-84 years), with a male predominance (86%). More than one half (55%) of the patients had had hypertension. In addition, 29 patients (37%) were symptomatic, and 24 (31%) had been admitted to the hospital. The symptomatic patients with celiac axis dissections were more likely to have thrombosis (P = .02), significant stenosis (P = .01) or branch extension (P = .02). The symptomatic patients with SMA dissections were more likely to have a smaller artery diameter (P = .07), a longer dissection length (P = .05), thrombosis (P < .001), significant stenosis (P < .001), or branch extension (P = .003). The symptomatic patients were more likely to have been treated with antiplatelet or anticoagulant therapy (P < .001). Only three patients had undergone an intervention. Seven patients (9%) had died of unrelated causes. The Kaplan-Meier survival analysis showed a 5-year survival rate of 96% and 10-year survival rate of 91%.ConclusionsIMAD is an uncommon disease entity with a risk of visceral ischemia. Nonetheless, most of these patients can be treated conservatively with medication, with only a small minority requiring emergency surgery.     

急性肠系膜上静脉血栓形成的诊断与治疗

目的 加深对急性肠系膜上静脉血栓形成(AMVT)导致急腹症严重性的认识,探讨提高疗效的措施。方法 对13例AMVT临床特点、治疗方法和效果进行分析比较。结果 入院均诊断为急腹症,但术前能确诊仅2例,拟诊1例,行小肠部分切除11例,其中小肠广泛切除3例,仅作剖腹探查2例。治愈10例,死亡3例。随诊3个月～14年,无复发,无短肠综合征发生。结论 AMVT临床表现无特异性,术前确诊困难。腹痛与腹部体征不符、WBC大于20×10~9/L时应警惕本病。彩色多普勒对诊断有较大帮助。充分认识此病,争取早期诊断及时手术是提高疗效关键,术后抗凝溶栓可防止复发。     

肠系膜上动脉压迫综合征的诊断和治疗

目的探讨肠系膜上动脉压迫综合征的病因、诊断和治疗方法。方法对1980年1月至2008年10月我院普外科收治的32例肠系膜上动脉压迫综合征的临床资料进行回顾性分析。结果本组均采用十二指肠空肠Roux-en-Y侧侧吻合加Treitz韧带松解术行手术治疗,术后病人症状均得到缓解,无死亡病例和并发症发生。结论肠系膜上动脉压迫综合征的主要确诊手段为X线钡餐造影;对保守治疗无效可采用手术治疗,十二指肠空肠侧侧Roux-en-Y吻合加Treitz韧带松解术为理想术式。     

孤立性肠系膜上动脉夹层的影像学诊断和治疗

孤立性肠系膜上动脉夹层是临床上的少见病,该病的治疗目前尚无统一方案.本研究回顾性分析2011年4月至2012年1月扬州大学临床医学院收治的3例孤立性肠系膜上动脉夹层患者的临床资料,旨在探讨该病的影像诊断和治疗效果.3例患者经过保守治疗后腹痛症状缓解不明显甚至加重,行血管腔内裸支架植入术治疗,术后继续给予抗凝、抗血小板治疗.3例患者支架腔内重建术均获成功,共植入7个裸支架;植入支架后患者的腹痛症状有不同程度减轻,3d后腹痛均消失.复查CT血管重建肠系膜上动脉内支架位置良好,支架腔内血流通畅,夹层及假腔消失.     

Laparoscopic management of superior mesenteric artery syndrome.

OBJECTIVES: The differential diagnosis of intestinal obstruction includes mechanical obstruction, obstruction secondary to systemic disease, and idiopathic intestinal pseudo-obstruction. The causes of these are extensive; however, the majority of cases involve a mechanical cause. Superior mesenteric artery syndrome (SMAS) is a rare and controversial form of mechanical obstruction with just over 300 well-defined cases described in the literature. The diagnosis is often difficult to establish, even after surgery. In addition, this syndrome sometimes may be managed conservatively, leaving a definitive diagnosis unproven. We describe herein 2 patients with SMAS successfully treated with laparoscopic duodenojejunostomy. METHODS: Two cases of SMAS occurred in young men ages 23 and 34. The workup included a consultation with a gastroenterologist, an upper gastrointestinal (GI) endoscopy, upper GI series with small bowel follow-through, computed tomography scan, ultrasound of the abdomen, and abdominal aortogram. This diagnosis was established after consultation with the surgeon and the gastroenterologist in each case. RESULTS: Laparoscopic duodenojejunostomy was performed in each case, and both patients have had complete resolution of their preoperative symptoms. CONCLUSIONS: A laparoscopic approach to the management of superior mesenteric artery syndrome is a reasonable and successful way of treating these patients.     

Aortic reimplantation of the superior mesenteric artery for atherosclerotic lesions of the visceral arteries: Sixty cases

We report the results of a series of patients who had isolated or associated reimplantation of the superior mesenteric artery directly into the infrarenal aorta. Between 1967 and 1988, a total of 91 revascularizations for atheromatous lesions of the visceral arteries were performed in 89 patients. The superior mesenteric artery was reconstructed in 87 instances, 60 of which were direct or indirect reimplantations into the juxtarenal aorta. The procedure was isolated in 51 cases, and associated with the revascularization of another visceral artery in nine cases. These 60 patients were divided into three groups: Group A—seven patients undergoing emergency operation for acute intestinal ischemia; Group B—30 patients operated upon for chronic intestinal angina; and Group C—22 asymptomatic patients who underwent prophylactic revascularization. Two patients died in the immediate postoperative period (3.5%). Although most of the 29 late deaths were due to vascular disorders, only one was secondary to intestinal infarction. Twenty-one patients followed had good functional results; six patients had relapse of abdominal pain. Three of these underwent repeat vevascularization of the superior mesenteric artery 12 days, 18 months, and 22 months, postoperatively. Follow-up ranged from six months to 18 years. Two patients were lost to follow-up. Overall actuarial survival at five years was 69.60±15%. In our experience, isolated reimplantation of the superior mesenteric artery on the anterior aspect of the infrarenal aorta is a simple and reliable technique which affords good long-term results.Presented at the Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, Strasbourg, France, June 23–24, 1989.     

The role of selective stenting for superior mesenteric artery scallops during fenestrated endovascular aneurysm repair

Objective

Stenting of small fenestrations of the Zenith fenestrated endograft (ZFEN; Cook Medical, Bloomington, Ind) is necessary during fenestrated endovascular aneurysm repair (FEVAR) of complex abdominal aortic aneurysms to avoid malalignment. However, stenting of superior mesenteric artery (SMA) scallops of ZFEN devices is optional according to the instructions for use. The objective of this study was to assess the early and midterm outcomes of selective use of stents in SMA scallops of ZFEN during FEVAR procedures.

肠系膜上动脉压迫综合征的诊疗分析

目的　总结肠系膜上动脉压迫综合征的诊断与治疗经验。方法　对我院 1 983年～2 0 0 2年诊治过的 1 6例病人的临床资料进行回顾性分析。结果　 1 6例病人均行钡餐造影检查 ,1 3例明确诊断 ;2例同时行腹部彩色多普勒超声确诊 ;另 2例同时行血管造影 ,明确诊断 ;1 6例病人均先行内科保守治疗 ,其中 8例因治疗无效而行手术治疗 ,包括十二指肠空肠Roux en Y吻合术 5例 ,十二指肠血管前移术 2例 ,胃大部切除、胃空肠吻合术 1例。术后病人全部随访 ,均痊愈。结论　钡餐造影、腹部彩色多普勒超声检查是肠系膜上动脉压迫综合征简单、可靠的诊断手段 ,十二指肠空肠吻合术是其有效、易行的手术方式     

肠系膜上静脉血栓形成的诊断和治疗

目的 探讨肠系膜上静脉血栓形成的诊断及治疗。方法 总结１２例ＭＶＴ的诊治经验,从病因,诊断和治疗等方面进行分析。结果：１２例均经手术病理证实,初诊多数表现为急腹症,症状和体征不相符,９例误诊,３例术前确诊,全部行手术治疗,８例治傅,４例死亡。结论该病少见,症状和体征无特异性,难以做出准确的诊断,Ｂ超和ＣＴ是较敏感的检查,对诊断有积极的作用。     

Laparoscopic Ladd's procedure for superior mesenteric artery syndrome

Superior mesenteric artery (SMA) syndrome is an uncommon condition where the third portion of the duodenum is compressed and obstructed between the SMA and the aorta. An otherwise healthy 17-year-old female presented with a 2-month history of postprandial abdominal pain and weight loss. Upper gastrointestinal (UGI) series demonstrated SMA obstruction of the third portion of the duodenum. Despite nasojejunal tube feedings over 4 months with appropriate weight gain, symptoms continued and repeat UGI demonstrated persistent SMA syndrome. A laparoscopic Ladd's procedure served as definitive treatment. The steps of the procedure include mobilization of the Ligament of Treitz, mobilization of the right colon, complete derotation of the duodenum, delivery of the small bowel to the right upper quadrant, and appendectomy. Following the procedure, a postoperative UGI showed complete resolution of SMA compression of the duodenum. The patient had an uneventful postoperative course with immediate resolution of symptoms. She was discharged home tolerating a regular diet.     

肠系膜上动脉压迫综合征的外科治疗

目的 对肠系膜上动脉压迫综合征(superior mesenteric artery compressing syndrome,SMACS)的诊断及术式选择进行评价。方法 对河南省人民医院2000年1月至2010年12月期间收治的28例SMACS患者的临床资料进行回顾性分析。结果 本组病例均行X线钡餐检查,有23例呈典型的十二指肠水平段与升段交界处纵行受压迫征象（笔杆征）。手术治疗28例,其中包括Treitz韧带切断松解术4例,单纯胃空肠吻合术2例,Treitz韧带松解加十二指肠空肠Roux-en-Y吻合术11例,胃大部切除、胃空肠吻合术（BillrothⅡ式）7例及肠系膜上血管前十二指肠空肠吻合术4例。全部病例均治愈出院。结论 SMACS主要的确诊手段为X线钡餐造影。手术治疗效果以Treitz韧带松解加十二指肠空肠Roux-en-Y吻合术为最佳。     

Aneurysm of the inferior mesenteric artery associated with occlusion of the celiac axis and superior mesenteric artery

The authors report a case of aneurysm of the inferior mesenteric artery encountered in a 38-year-old man, associated with occlusion of the celiac axis, the superior mesenteric artery and the inferior mesenteric artery distal to the aneurysm. All three arteries were revascularized. In spite of failure in the bypass of the superior mesenteric artery, the patient remained symptom free until his demise four years later, from a probable myocardial infarction. Only 11 cases of aneurysms of the inferior mesenteric artery have been reported in the literature. The causes, diagnosis and treatment of these uncommon lesions are discussed. When occlusion of the celiac axis is associated with that of the superior mesenteric artery, a complete mesenteric revascularization should be attempted whenever possible.     

Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome.

BACKGROUND: Superior mesenteric artery (Wilkie's) syndrome is a rare condition. Only 400 cases have been reported so far. The symptoms may be acute or chronic, the chronic form being more common. Vomiting is the most common symptom. About 15 causal factors have been found. Conservative management is the rule for acute cases. Surgery is indicated for chronic cases and failure of conservative management. Laparoscopy has been used in only 8 cases so far. CASE REPORT: We report the ninth case of superior mesenteric artery syndrome managed by laparoscopic duodenojejunostomy. The patient was a 14-year-old boy with chronic symptoms since childhood. The procedure was relatively straightforward. The case is being reported for its rarity and the possibility of laparoscopic management. DISCUSSION: Laparoscopic severing of Treitz's ligament is another surgical option, though gastrojejunostomy is of no use. Conservative management is useful only in acute cases. CONCLUSION: Duodenojejunostomy is the procedure of choice and is effective in 90% of patients. We conclude that it is very effective in this condition, especially laparoscopically.     

十二指肠空肠吻合术治疗肠系膜上动脉综合征的评价

目的:评价十二指肠空肠吻合术治疗肠系膜上动脉综合征((SMAS)的价值。方法:分析1959年1月—2012年12月采用十二指肠空肠吻合术治疗的SMAS88例患者的临床资料。结果:本组患者主要症状为餐后上腹胀痛和频繁呕吐,呕吐物含胆汁;经CT检查结合X线钡餐造影诊断为SMAS。88例均经手术治疗,其中70例(79.5%)效果优良,痊愈出院;18例(20.5%)效果不良,又出现术前症状,术后2周~3个月再行钡餐X线造影显示十二指肠空肠吻合口通畅,十二指肠逆蠕动仍然强烈,逆蠕动顺蠕动,钡剂逆流入胃,胃扩张无力。此18例二次改行十二指肠环形引流术,术后痊愈。结论:SMAS一旦成为习惯性逆蠕动,就难以消除,即使行十二指肠空肠吻合术解除十二指肠梗阻,临床症状也不能改善,其治疗关键是解决逆蠕动问题。采用十二指肠环形引流术能解决十二指肠内容物的引流方向,使呕吐等症状消除。     

胃肠功能因素对骨科患者肠系膜上动脉综合征的影响

目的：探讨肠系膜上动脉综合征的发生机理，分析胃肠功能因素在该综合征中的作用。方法：联系骨科临床中常见的腹胀、便秘(胃肠功能紊乱)，观察19例非脊柱矫形病人发生的系膜上动脉综合征的发生、发展、治疗，分析其共同规律并研究其发生机理。结果：所有病例均发生于入院或术后1～2周，痊愈后无复发，此综合征因医疗干预时期不同及胃肠功能恢复速度不同而所需痊愈时间不同。结论：胃肠功能因素在系膜上动脉综合征的发生中起重要作用。该综合征是局部解剖因素及胃肠功能因素共同作用，并使胃肠通过功能进入恶性循环的结果，其治疗即是及时阻断此恶性循环，一般并不需手术治疗。     

Surgical therapy for acute superior mesenteric artery embolism

BACKGROUND: Acute mesenteric artery embolism has a high rate of morbidity and mortality. Early diagnosis and appropriate treatment are the most important factors associated with morbidity and mortality. METHODS: During the period between 1997 and 2002, 24 patients underwent superior mesenteric artery embolectomy. The patients were divided into three groups according to the onset of symptoms and operation time. Group I (n = 12) patients were operated on in the first 6 hours after onset of symptoms; group II (n = 9) patients were operated on between 6 and 12 hours after onset; and group III (n = 3) patients underwent embolectomy after 12 hours. Low-dose (5 to 10 mg) local tissue-type plasminogen activator (t-PA) administration directly into the superior mesenteric artery was an additional procedure with the embolectomy in all patients. RESULTS: The macroscopic view of the intestine was normal in 15 patients (12 patients in group I and 3 patients in group II) 30 minutes after the administration of local t-PA. Segmental resection was necessary in 4 patients in group II. Extended resection was necessary in 2 patients in group II and 3 patients in group III, and all of the patients died during the early postoperative period. CONCLUSIONS: We suggest that explorative laparotomy should be done in patients with sudden abdominal pain, nausea, vomiting, mild leukocytosis, and metabolic acidosis who have previous valvular heart disease or atrial fibrillation. Ultimately, selective low dose t-PA (5 to 10 mg) administration reduces the length of intestinal portion to be resected.