肠系膜上动脉综合征一例

患者女,18岁。因“反复进食后呕吐,伴消瘦2年余”入院胃肠内科。入院半年前曾因出现中上腹胀痛多次于外地医院就诊,胃镜检查结果仅提示胃窦炎伴胃黏膜糜烂,予以促消化治疗后症状无明显改善。月经史：14岁初潮,每次5-6d,量可,无痛经,3年前闭经。查体示体型消瘦,BMI为13．1kg／m^2,右上腹部轻压痛,墨菲氏征可疑阳性,振水音（＋）,其余体征阴性。     

瘢痕性幽门梗阻并肠系膜上动脉综合征一例

患者男,19岁,因进食后上腹部饱胀不适伴呕吐宿食7月余入院.患者3年前在外院诊断为胃十二指肠复合性溃疡,未规律服药,7月前开始出现进食后上腹部饱胀不适伴呕吐宿食,外院予胃肠减压、抑酸及营养支持后症状可缓解,但病情反复,4月前行胃镜下幽门球囊扩张术,术后病情好转,但近两月来患者进食稍多即觉得上腹部胀满不适,诱发呕吐或俯卧位后可缓解,近6月来体重下降约15 kg.1月前来我院就诊,查体:身高165 cm,体重40 kg,舟状腹,上腹可见胃型.     

风湿性心脏病并急性肠系膜上动脉栓塞3例误诊分析

急性肠系膜上动脉栓塞是危重急腹症之一,由于病情发展迅速,诊断困难、病死率高达76%～100%。如能早期诊断,或及时手术治疗,常可收到较好效果。现将笔者经治3例风湿性心脏病并发本病的诊治     

肠系膜动脉十二指肠压迫综合征

此综合征又名Wilkie综合征、肠系膜上动脉综合征、主动脉肠系膜动脉压迫综合征和慢性十二指肠淤滞症。这是少见的一种十二指肠水平部和/或上升部位梗阻。1927年Wilkie收集报告75例慢性十二指肠梗阻,指出其是具有特征的综合征,表现为进食后上腹痛、嗳气、饱胀,常伴有大量的呕吐物。症状为间隙性发作,持续1~2d,此后可以缓解数周。慢性病程常使病人体重明显下降和消瘦,有半数病人在发作时如果病人取左卧位或俯卧胸膝位可使症状得到部分缓解。故文献中称Wilkie综合征[1]。一、病因肠系膜上动脉从腹主动脉腹侧发出走向尾侧方向,它与腹主动脉形…     

十二指肠移位术治疗肠系膜上动脉综合征

因十二指肠第三段位于肠系膜上动脉与腹主动脉形成的夹角之内,在某些情况下,肠系膜上动脉可以压迫十二指肠而形成肠梗阻,称之为肠系膜上动脉综合征(superior mesenteric artery syndrome,SMAS)。对于其外科治疗,常用的术式有:1.屈氏韧带松解术;2.十二指肠空肠侧侧吻合术;3.     

重度烧伤合并肠系膜上动脉综合征一例

男,19岁。全身多处酒精烧伤3小时于1993年5月25日入院。烧伤总面积为86%,其中Ⅲ度23%,伴休克。经扩容等处理,伤后第5天行双下肢13%创面切痂,自体皮拉网移植。第15天出现频繁呕吐,呕吐物为胆汁,平卧位剑突下可闻及收缩期杂音。钡餐透视示十二指肠降段远端梗阻,左侧卧位或俯卧位时少许钡剂     

重度烧伤合并肠系膜上动脉综合征一例

重度烧伤合并肠系膜上动脉综合征一例李小毅刘国永肖逊昌叶莲珠男，１９岁。全身多处酒精烧伤３小时于１９９３年５月２５日入院。烧伤总面积为８６％，其中Ⅲ度２３％，伴休克。经扩容等处理，伤后第５天行双下肢１３％创面切痂，自体皮拉网移植。第１５天出现频繁呕吐，...     

胆石致十二指肠梗阻一例

患者女,50岁,右上腹部疼痛20余年。既往诊断:胆囊炎,胆石症。7年前曾做过胆囊切除,胆总管切开取石,术后仍出现上腹部疼痛,疼痛时伴有黄疸出现,时有畏寒发热。7天前腹痛加剧,且呕吐,以胆道术后残余结石伴感染收入住院。在入院保守治疗的第3天,患者突感右上腹部阵发性疼痛后,呕吐暗绿色水样胆汁样物约100ml 左右,疼痛自行缓解,且排黑色稀大便1次,大便潜血(+++)。3小时后出现频繁呕吐,吐出物仍为绿色水样液体,伴阵发性腹痛。检查:体温37.40℃,脉搏88次/分,血压110/70。皮肤、巩膜轻度黄染。右上腹部压痛反跳痛明显,     

急性肠系膜上动脉栓塞一例解析

1临床资料 患者,男性,79岁,无明显诱因出现中下腹部持续性胀痛2d,于2012年6月5日由外院转入.腹痛阵发性加剧,无放射,伴有恶心、呕吐及腹泻,呕吐物为胃内容物,大便7～8次/d,黄色稀便.入院前经补液抗感染治疗无缓解.既往有高血压、冠心病、2型糖尿病20余年,2年前因脑梗塞出现左侧肢体瘫痪.查体:体温38℃,脉搏114次/min,呼吸20次/min,血压152/100 mm Hg(1 mm Hg =0.133 kPa).急性痛苦面容,平车推入病房,神志清楚,语言不流利.心律不齐,心音强弱不等,脉搏细弱.腹部膨隆,全腹部压痛、反跳痛明显,伴轻度肌紧张,未触及包块;肠鸣音消失全腹部增强CT及血管重建成像检查提示:肠系膜上动脉血栓形成,右肾动脉重度狭窄(95％)、主动脉粥样斑块形成;肠管扩张积液.下肢血管超声提示:双下肢动脉硬化闭塞.心电图提示:房颤.血常规:WBC15.87×109/L、中性89.7％、HGB 172 g/L.     

Duodenal diaphragm associated with superior mesenteric artery syndrome

An unusual case of duodenal diaphragm in a 24 year old patient who presented with symptoms of the superior mesenteric artery syndrome is presented. The patient had rheumatoid arthritis and had been treated with salicylates, which were thought to have produced inflammation and occlusion of the aperture to the point of complete obstruction. Complete excision of the diaphragm through anterior duodenotomy and distal duodenojejunostomy provided an excellent result.     

Late superior mesenteric artery syndrome in paraplegia: case report and review

STUDY DESIGN: A case report of superior mesenteric artery syndrome (SMA syndrome) occurring in a paraplegic patient 3 months after injury. OBJECTIVES: To report an unusual case and review the literature of SMA syndrome in spinal cord injured patients, focusing on paraplegic subjects and on tardive presentations. SETTING: A Physical Medicine and Rehabilitation Center in Garches (France). METHOD: Current medical literature includes reports of only 14 spinal cord injured patients with SMA syndrome. This syndrome has been often described in anorexia nervosa, burns or other causes of cachexia, following correction of spinal deformities or after application of body casts. RESULTS: In spinal cord injured patients SMA usually occurs in tetraplegic patients during the first weeks after injury. Only four cases of SMA syndrome in paraplegic patients have been described. Late forms are less common than acute ones: only three cases among 14. SMA syndrome consists of a vascular compression of the third part of the duodenum between the ventrally oriented SMA and the aorta. The normal aorto-mesenteric angle ranges between 38 degrees and 65 degrees and can be as low as 6 degrees in patients with SMA syndrome. The diagnosis is usually based on upper gastro-intestinal contrast X-ray study, which shows abrupt vertical compression of the third part of the duodenum. CT scan with angiography is useful in some difficult cases. Conservative management includes early correction of dehydration and electrolyte imbalance, insertion of a nasojejunal tube beyond the obstruction and renutrition. Duodenojejunostomy may be necessary in case of failure of conservative treatment. CONCLUSION: SMA syndrome is an unusual gastro-intestinal complication that may occur in paraplegic patients, even late after injury.     

A case report of B-cell lymphoma masquerading as superior mesenteric artery syndrome

Superior mesenteric artery (SMA) syndrome is a rare cause of intestinal obstruction, especially in children, whereas intussusception is far more common. We report the case of a child, who after an episode of acute weight loss presented with features suggestive of SMA syndrome. This child subsequently was shown at operation to have disseminated lymphoma causing a secondary high jejunal intussusception and tumor involvement of retroperitoneal lymph nodes causing compression of the third part of the duodenum. This case emphasizes that the SMA syndrome should be considered a sign rather than a diagnosis in itself. As such, an active search should be made to determine the cause of the condition. Routine preoperative imaging is recommended.     

Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome: report of a case

Vascular compression of the duodenum is also known as superior mesenteric artery syndrome (SMA syndrome) or Wilkie syndrome. This is a rare condition that is characterized by compression of the third portion of the duodenum by the SMA as it passes over this portion of the duodenum. Duodenojejunostomy is usually considered to be the treatment of choice. We recently experienced the case of a very thin 19-year-old female with the diagnosis of SMA syndrome. We started nasogastric tube decompression and total parenteral nutrition, but that was ineffective; we then performed laparoscopic duodenojejunostomy. We herein report on this successful laparoscopic duodenojejunostomy procedure along with a review of the relevant literature.     

Extrapleural pneumonectomy complicated by acute superior mesenteric artery syndrome

We present a patient who developed an acute superior mesenteric artery (SMA) syndrome following pneumonectomy. Although rarely described, a majority of cases develop insidiously from a gradual loss of retroperitoneal fat in the setting of malnourishment. A postoperative presentation is atypical, however procedures that narrow the aortomesenteric angle have been associated with the development of SMA syndrome. This case illustrates an important anatomic relationship that thoracic surgeons performing lung resection surgery should be aware of in order to avoid predisposing patients to SMA syndrome.     

Five-centimeter superior mesenteric artery aneurysm. A case report

An unusual large mesenteric artery aneurysm presented as "angina abdominis" and abdominal mass is described. Endoaneurismectomy with reverse end-to-end saphenous vein graft was performed. The incidence, pathogenesis and diagnosis are reviewed and the treatment is discussed.