Severe malnutrition causing superior mesenteric artery syndrome in an adolescent with Triple A syndrome

2016 ◽  
Vol 29 (10) ◽  
Author(s):  
Christy Foster ◽  
Abha Choudhary
Keyword(s):  
Superior Mesenteric Artery ◽  
Adrenal Insufficiency ◽  
Mesenteric Artery ◽  
Delayed Diagnosis ◽  
Superior Mesenteric Artery Syndrome ◽  
Adolescent Male ◽  
Severe Malnutrition ◽  
Triple A Syndrome ◽  
Allgrove Syndrome ◽  
Sma Syndrome

AbstractTriple A syndrome, formerly known as Allgrove syndrome (AS), is characterized by achalasia, alacrima and adrenal insufficiency. Here we report an adolescent male with adrenal insufficiency who developed severe malnutrition secondary to a delayed diagnosis of achalasia. The severe malnutrition in our patient led to superior mesenteric artery (SMA) obstruction syndrome. Severe malnutrition to the point of SMA syndrome has not been previously described in the literature in Triple A syndrome.

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 Superior Mesenteric Artery Syndrome: A Single-institution Experience

2021 ◽  
Vol 3 (1) ◽  
pp. FIRST
Author(s):  
Chun-huang Chen ◽  
Victor T.K. Chen ◽  
Shao-Jiun Chou ◽  
Hsiang-Chun Jan ◽  
Tzu-Hung Chen ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Surgical Intervention ◽  
Water Soluble ◽  
Superior Mesenteric Artery Syndrome ◽  
Electrolyte Imbalance ◽  
Surgical Approaches ◽  
Severe Malnutrition ◽  
Mini Laparotomy

Background: Superior mesenteric artery syndrome (SMAS) is a rare disease in adult. SMAS is characterized by acute, or, more commonly, chronic nonspecific symptoms due to duodenal obstruction and severe malnutrition with reduced arterio-mesenteric angle and distance. Surgical treatment may be necessary in most cases with chronic symptoms or when conservative treatment fails in SMAS. Methods: A retrospective chart review was performed on patients who underwent operation for SMAS from January 2008 to August 2020 in Cardinal Tien Hospital. Patients’ clinical presentations, surgical intervention, and outcomes. Results: Data from a total of 14 patients diagnosed with SMAS were analyzed, of which seven were diagnosed with SMAS by abdominal computed tomography and upper gastrointestinal series with water-soluble barium contrast. Six of the confirmed cases underwent surgery, namely, gastric decompression using a nasogastric tube, and correction of electrolyte imbalance. The nasoduodenal tube was placed through the obstructed duodenum to provide a high-nutrient fluid supplement. After conservative treatment failure, the patients underwent surgery. Of the six patients, four underwent duodenojejunostomy, one underwent a mini-laparotomy duodenojejunostomy bypass, and the last one underwent Roux-en-Y duodenojejunal bypass with duodenal feeding tube insertion. Conclusion: Patients with SMAS should initially be treated conservative. Surgical intervention should be considered in patients in whom conservative treatments were not effective. Complete resolution of all symptoms may not always be guaranteed after surgical intervention. Laparoscopy is currently widely used. In well-selected patients, minimally invasive or mini-laparotomy duodenojejunostomy is a safe and effective treatment for SMAS. The main advantages of mini-laparotomy duodenojejunostomy over other surgical approaches include half-length surgical incision and a shorter operative time. Duodenojejunostomy is rapidly becoming the standard procedure of this condition, and it has excellent outcomes comparable with those of open surgery.

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 Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice

2017 ◽  
Vol 99 (6) ◽  
pp. 472-475 ◽  
Author(s):  
GC Kirby ◽  
ER Faulconer ◽  
SJ Robinson ◽  
A Perry ◽  
R Downing
Keyword(s):  
Weight Loss ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Epigastric Pain ◽  
Superior Mesenteric Artery Syndrome ◽  
Team Approach ◽  
The Third ◽  
Wilkie’S Syndrome ◽  
Sma Syndrome ◽  
Open Gastrojejunostomy

INTRODUCTION The superior mesenteric artery (SMA) syndrome, or Wilkie’s syndrome, is a rare cause of postprandial epigastric pain, vomiting and weight loss caused by compression of the third part of the duodenum as it passes beneath the proximal superior mesenteric artery. The syndrome may be precipitated by sudden weight loss secondary to other pathologies, such as trauma, malignancy or eating disorders. Diagnosis is confirmed by angiography, which reveals a reduced aorto-SMA angle and distance, and contrast studies showing duodenal obstruction. Conservative management aims to increase intra-abdominal fat by dietary manipulation and thereby increase the angle between the SMA and aorta. Where surgery is indicated, division of the ligament of Treitz, anterior transposition of the third part of the duodenum and duodenojejunostomy have been described. METHODS We present four cases of SMA syndrome where the intention of treatment was laparoscopic duodenojejunostomy. The procedure was completed successfully in three patients, who recovered quickly with no short-term complications. A fourth patient underwent open gastrojejunostomy (complicated by an anastomotic bleed) when dense adhesions prevented duodenojejunostomy. CONCLUSIONS The superior mesenteric artery syndrome should be considered in patients with epigastric pain, prolonged vomiting and weight loss. Laparoscopic duodenojejunostomy is a safe and effective operation for management of the syndrome. A multi-speciality team approach including gastrointestinal, vascular and radiological specialists should be invoked in the management of these patients.

scholarly journals Delayed Diagnosis of an Eating Disorder in a Male Patient With Superior Mesenteric Artery Syndrome: Results From a Case Study

2019 ◽  
Vol 10 ◽  
Author(s):  
María Recio-Barbero ◽  
Sara Fuertes-Soriano ◽  
Janire Cabezas-Garduño ◽  
Mayte López-Atanes ◽  
Alvar Peña-Rotella ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Superior Mesenteric Artery ◽  
Male Patient ◽  
Mesenteric Artery ◽  
Delayed Diagnosis ◽  
Superior Mesenteric Artery Syndrome

scholarly journals Superior mesenteric artery syndrome masquerading as chronic gastric volvulus in a child with severe acute malnutrition: a case report

2020 ◽  
Vol 7 (8) ◽  
pp. 2758
Author(s):  
M. Mokarram Ali ◽  
Amit Kumar ◽  
Rashi . ◽  
Amit K. Sinha ◽  
Bindey Kumar
Keyword(s):  
Intestinal Obstruction ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Severe Acute Malnutrition ◽  
Gastric Volvulus ◽  
Acute Malnutrition ◽  
Severe Malnutrition ◽  
Sma Syndrome ◽  
Paediatric Age ◽  
High Index Of Suspicion

Superior mesenteric artery (SMA) syndrome is a rare cause of high intestinal obstruction. It is commonly seen in severely malnourished patients presenting with repeated episodes of vomiting. We report a case of SMA syndrome in a 3 years old male child provisionally diagnosed as chronic gastric volvulus with severe acute malnutrition. The diagnosis of SMA syndrome was confirmed on abdominal exploration. SMA syndrome is a rare case of intestinal obstruction in paediatric age group. Chronic malnutrition is one of the common causes of this entity. There should be a high index of suspicion for this syndrome when we encounter a child with severe malnutrition and recurrent vomiting.

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