scholarly journals 1517 Case Report: Concomitant Superior Mesenteric Artery and Nutcracker Syndrome

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M G Rivera Cartland ◽  
R Camprodon
Keyword(s):  
Case Report ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Multidetector Ct ◽  
Left Renal Vein ◽  
Outlet Obstruction ◽  
Vascular Compression ◽  
Sma Syndrome ◽  
Surgical Bypass ◽  
Operative Findings

Abstract Background Superior mesenteric artery (SMA) syndrome is a rare1 upper gastrointestinal emergency and diagnosis is reached by a high clinical suspicion and confirmed on CT scan. It classically occurs from the compression of the third part of the duodenum (D3) due to a reduced aorto-mesenteric angle2. Case report A 28-year-old Caucasian female presented with a 4-day history of persistent vomiting, generalised abdominal pain, distension and absolute constipation for 3 days. She has no previous past medical history. On examination, she had a BMI of 17. Her abdomen was distended with generalised tenderness on palpation. Her routine blood results showed stage 2 acute renal failure. CT abdomen and pelvis showed a grossly dilated stomach and part 1& 2 of duodenum. She underwent an emergency Roux-en-Y duodeno-jejunostomy and end-side jejuno-jejunal anastomosis. Operative findings were of a grossly distended stomach and D1/2 with superior mesenteric vessels impinging on D3 and on left renal vein. Conclusions SMA syndrome is a rare cause of gastric outlet obstruction and following initial hydration and correction of electrolytes a definitive procedure should be considered. Many surgeons favour a conservative approach with a period of ‘fattening’ to increase the aorto-mesenteric angle prior to surgical management. We believe that this only delays the inevitable and patients are best serviced with early surgical bypass. References 1. Biswas A. Superior mesenteric artery syndrome: CT findings. BMJ Case Rep. 2016 2. Multidetector CT of vascular compression syndromes in the abdomen and pelvis. RadioGraphics 2014;34:93–115. 10.1148/rg.341125010

scholarly journals Superior mesenteric artery syndrome causing gastric outlet obstruction: A myth in acute abdomen

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Norfaidhi Akram MN ◽  
◽  
Husni S ◽  
Sarmukh S ◽  
Azmi H ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Acute Abdomen ◽  
Gastric Outlet Obstruction ◽  
Mesenteric Artery ◽  
Treatment Options ◽  
Outlet Obstruction ◽  
Acute Onset ◽  
Superior Mesenteric Artery Syndrome ◽  
Vascular Compression ◽  
Sma Syndrome

Objective: We aim to report a case of gastric outlet obstruction in adolescence that was diagnosed as a superior mesenteric artery syndrome and treated successfully by gastrojejunostomy. Case report: A 17-year-old female presented to emergency department with acute abdomen. She was also complaint of significant weight loss past 2 months. On clinical examination she was underweight with fullness of upper abdomen down to umbilicus. Oesophagogastroduodenoscopy (OGDS) was performed showed grossly dilated stomach with unable to go beyond D3 region. Contrast Enhanced Computed Tomography (CECT) abdomen suggestive of Superior Mesentery Artery (SMA) syndrome. She was subjected to gastrojejunostomy and recovered well postoperatively. Conclusion: An acute onset of gastric outlet obstruction in adolescence can be a diagnostic and treatment challenging. Our case patient was diagnosed as a SMA syndrome based on the history taking and CT findings. We would like to advocate a high index of suspicious SMA syndrome should be included in an acute abdomen in adolescence besides volvulus and malrotation. The treatment options should be individualized. In this case we opted for a gastrojejunostomy compared to duodenojejunostomy. The decision was made based on the patient nutritional status as patient was low Body Mass Index (BMI) was 16 kg/m2 which carries a high risk of anastomotic leak. Keywords: superior mesenteric artery syndrome; cast syndrome; wilkie’s syndrome; arteriomesenteric duodenal compression; duodenal vascular compression.

scholarly journals Facts and fantasies about superior mesenteric artery syndrome: an unusual cause of intestinal obstruction

2019 ◽  
Vol 6 (7) ◽  
pp. 2591
Author(s):  
Swapnil Singh Kushwaha ◽  
Shikha Goja
Keyword(s):  
Intestinal Obstruction ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Early Recognition ◽  
Recurrent Abdominal Pain ◽  
Favourable Outcome ◽  
Vascular Compression ◽  
Fatty Tissue ◽  
Diagnostic Dilemma ◽  
Sma Syndrome

Superior mesenteric artery (SMA) syndrome (also known as Wilkie’s syndrome) is an unusual cause of proximal intestinal obstruction, attributable to vascular compression of the third part of duodenum between the superior mesenteric artery and the abdominal aorta due to acute angulation of SMA. It is a life threatening disease as it poses a diagnostic dilemma and often diagnosed by exclusion of other causes. It is an acquired disorder and is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a case of SMA syndrome in a 23 year young asthenic female patient, with a long history of recurrent abdominal pain, epigastric fullness, voluminous vomiting, and weight loss. Symptoms persisted for 1 year and the patient underwent extensive investigations, but to no avail. Thereafter she developed proximal intestinal obstruction, which unravelled her diagnosis. Abdominal examination revealed epigastric fullness, tenderness and hyper peristaltic bowel sounds. We performed small bowel enteroclysis, upper gastrointestinal series, abdominal computer-tomography (CT) and ultrasonography to establish the diagnosis. Conservative treatment was tried for one month but failed. There was no relief of symptoms in the left lateral decubitus or prone position. Finally, the patient successfully underwent Roux-en-Y duodenojejunal anastomosis with a postoperative favourable outcome. This case emphasizes the challenges in the diagnosis of SMA syndrome and the need for increased awareness of this entity. This will improve early recognition in order to reduce irrelevant tests and unnecessary treatments.

scholarly journals Case Report of a Superior Mesenteric Artery Syndrome in an Autistic Patient with Schizophrenia

2021 ◽  
pp. 21
Author(s):  
Lee Mem Tim ◽  
Bernard Ho Kar Eng ◽  
Sentilnathan Subramaniam ◽  
Harivinthan Sellappan
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Ct Scan ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Superior Mesenteric Artery Syndrome ◽  
Autistic Patient ◽  
Gastrointestinal Obstruction ◽  
Sma Syndrome ◽  
Upper Gastrointestinal

Introduction: Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction. Diagnosis is confirmed via computed tomography (CT) scan showing acute angulation at the origin of superior mesenteric artery compressing on the duodenum causing proximal dilatation of the second part of duodenum.

A CASE REPORT : A CASE OF SUPERIOR MESENTERIC ARTERY SYNDROME

2021 ◽  
pp. 7-7
Author(s):  
Madhav Santoki ◽  
Alpesh Amin
Keyword(s):  
Case Report ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Duodenal Obstruction ◽  
Superior Mesenteric Artery Syndrome ◽  
Clinical Entity ◽  
The Third ◽  
Sma Syndrome ◽  
Transverse Portion

Superior mesenteric artery (SMA) syndrome is an uncommon but well recognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum between the aorta and the superior mesenteric artery. This results in chronic, intermittent, or acute complete or partial duodenal obstruction. Superior mesenteric artery syndrome was rst described in 1861 by Von Rokitansky, who proposed that its cause was obstruction of the third part of the duodenum as a result of arterio-mesenteric compression. Some studies report the incidence of superior mesenteric artery syndrome to be 0.1- 0.3%.

scholarly journals Nutcracker Syndrome Accompanying With Superior Mesenteric Artery Syndrome: A Case Report

2019 ◽  
Vol 12 ◽  
pp. 117954761985538
Author(s):  
Nabil A Al-Zoubi
Keyword(s):  
Case Report ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Past History ◽  
Left Renal Vein ◽  
Superior Mesenteric Artery Syndrome ◽  
Uneventful Recovery ◽  
Nutcracker Syndrome ◽  
Ct Angiogram ◽  
Renal Nutcracker Syndrome

Purpose: The duodenum and the left renal vein (LRV) occupy the vascular angle made by the superior mesenteric artery (SMA) and the aorta. When the angle becomes too acute, compression of either structure can occur. Although superior mesenteric artery syndrome (SMAS) and renal Nutcracker syndrome (NCS) share the same pathogenesis, concurrent development has rarely been reported. Case report: A 38-year-old female patient with a past history of gastrojejunostomy operated 6 years ago due to SMAS. She referred to vascular clinic with sever intermittent left-sided loin pain during the last 6 years. Computed tomography (CT)-angiogram and selective LRV angiogram with pressure gradient confirmed the diagnosis of NCS. She was treated by LRV transposition with uneventful recovery and considerable relief of symptoms. Conclusions: NCS accompanying with SMAS is quite unusual. A patient, who first presents with clinical evidence of SMAS, could also simultaneously or sometime thereafter present with NCS and vice versa.

Laparoscopic Duodenojejunostomy for Superior Mesenteric Artery Syndrome

2010 ◽  
Vol 76 (3) ◽  
pp. 321-324 ◽  
Author(s):  
Gitonga Munene ◽  
Michel Knab ◽  
Bhanot Parag
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Critical Appraisal ◽  
Case Reports ◽  
Case Series ◽  
Standard Of Care ◽  
Morbidity Rate ◽  
Vascular Compression ◽  
Sma Syndrome ◽  
Uncommon Condition

Superior mesenteric artery (SMA) syndrome is an uncommon condition of duodenal obstruction secondary to extrinsic vascular compression. With the advent of laparoscopy, an emerging option to treat SMA syndrome is laparoscopic duodenojejunostomy. Given the rarity of the condition a critical appraisal of the effectiveness and safety of this relatively new surgical option has not been performed. Here we present a case report and a critical review of all published reports of laparoscopic duodenojejunostomy. A systematic literature review of all published reports describing laparoscopic duodenojejunostomy was performed by querying the MEDLINE database using keywords: laparoscopic duodenojejunostomy and SMA syndrome. Nine articles were reviewed which were mainly case reports and case series (level 5 data), reporting on a total of 13 patients, with 32 per cent of the patients being male and 68 per cent female. The diagnosis was established preoperatively in 62 per cent of the cases, the length of stay was 4.5 days, the morbidity rate was 7 per cent, and no mortalities were reported. The operation was considered successful in 100 per cent of patients. Laparoscopic duodenojejunostomy seems to be a safe and effective treatment for patients with SMA syndrome, but more data is required to recommend this operative option as the standard of care.

scholarly journals Laparoscopic Hand-Sewn Duodenojejunostomy for Superior Mesenteric Artery Syndrome Using 3D-4K Image - A Case Study

2022 ◽  
Vol 40 (1) ◽  
pp. 68-71
Author(s):  
Md Jahangir Hossan Bhuiyan ◽  
Farhana Begum ◽  
Mohammad Anwar Hossain
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Duodenal Obstruction ◽  
Intraoperative Complications ◽  
Rare Condition ◽  
Cost Effective ◽  
Vascular Compression ◽  
Invasive Approach ◽  
Intracorporeal Suturing ◽  
Sma Syndrome

Background: Superior mesenteric artery (SMA) syndrome, also known as wilkie’s syndrome, is a rare condition characterized by vascular compression of third part of the duodenum that leads to duodenal obstruction. Traditionally, open or laparoscopic stapled duodenojejunostomy is recommended when conservative management failed. We report a 3D-4K image hand-sewn duodenojejunostomy (DJ) for the treatment of SMA syndrome. Materials and Methods: A 13 years old patient presented with anorexia, post prandial vomiting, dull abdominal pain & weight loss for 6 years. Upper GI endoscopy revealed duodenal stenosis and Barium follow through demonstrated obstruction to the third part of the duodenum. Ultrasound examination revealed gastric & duodenal dilatation. With these clinical and radiological findings, the diagnosis of SMA syndrome was suspected. He was identified as a candidate for a duodenojejunostomy. 3D-4K image system was used for superior image quality and binocular depth perception and a laparoscopic hand-sewn duodenojejunostomy performed on september 20, 2020 Results: Diagnostic laparoscopy detected SMA syndrome. Laparoscopic hand-sewn duodenojejunostomy took 120 minutes time. There were no intraoperative complications. The blood loss was minimum. The postoperative course was uneventful with resolution of duodenal obstruction. The patient discharged on 6th postoperative day. He gained 10 kg weight 6weeks after surgery. Conclusion: 3D-4K image laparoscopic hand-sewn duodenojejunostomy as a surgical option for the treatment of SMA syndrome is safe, cost effective, feasible, and valid alternative to open and laparoscopic stapled technique with added benefits of a minimally invasive approach. Additionally hand-sewn anastomosis ensures good tissue approximation. Of course it is time consuming and needs expertise in intracorporeal suturing. 3D-4K image technology makes this difficult procedure easier. J Bangladesh Coll Phys Surg 2022; 40: 68-71

scholarly journals Nutcracker Syndrome Masquerading as Renal Colic in an Adolescent Athlete: A Case Report

2021 ◽  
Vol 5 (4) ◽  
pp. 415-418
Author(s):  
Ron Waldrop ◽  
Paul Henning
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Renal Colic ◽  
Left Renal Vein ◽  
Flank Pain ◽  
Distance Runner ◽  
Nutcracker Syndrome

Introduction: Abdominal pain and flank pain cause a significant proportion of emergency department (ED) visits. The diagnosis often remains unclear and is frequently associated with repeat visits to the ED for the same complaint. A rare cause of left upper abdominal and flank pain is compression of the left renal vein between the aorta and the superior mesenteric artery known as nutcracker syndrome. Diagnostic findings on ultrasound include increased left renal vein diameter proximal and peak blood flow velocity increase distal to the superior mesenteric artery. We describe such a patient presenting to an ED repeatedly with severe pain mimicking renal colic before the final diagnosis and intervention occurred. Case Report: A 16-year-old female, long-distance runner presented four times complaining of intractable left upper quadrant abdominal pain radiating to the left flank after exercise. On each visit urinalysis revealed proteinuria and hematuria, and on two visits abdominal computed tomography revealed no kidney stone or dilatation of the collecting system. Ultimately, she was referred to vascular surgery where Doppler ultrasonography was used to diagnose left renal vein compression. Transposition of the left renal vein improved Doppler diameter and flow measurements and eliminated symptoms. Conclusion: Emergency physicians must maintain a large list of possible diagnoses during the evaluation of abdominal and flank pain with a repetitive and uncertain etiology. Nutcracker syndrome may mimic other causes of abdominal and flank pain such as renal colic and requires appropriate referral.

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