Syndrome of duodenal compression by the superior mesenteric artery following restorative proctocolectomy: a case report and review of literature

Matheus, Cláudio de Oliveira; Waisberg, Jaques; Zewer, Maria Helena de Toledo; Godoy, Antônio Cláudio de

doi:10.1590/s1516-31802005000300013

Cited by 34 publications

(29 citation statements)

References 5 publications

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“…Significant weight loss decreases the amount of retroperitoneal fat between the superior mesenteric artery and the aorta, thus removing a major source of cushioning for the duodenum and allowing duodenal compression. 2 Although there are several studiesthat mention the significance of the angle and distance between the SMA and the aorta in the etiology of SMAS, [3][4][5][6][7][8][9] very few studies have been conducted to evaluate the association between the angle of SMA and the amount of intraabdominal fat in the normal population. [10][11][12] In such studies, body mass index (BMI) has frequently been used to estimate the amount of abdominal fat.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the relationship between intraabdominal fat thickness and the aortomesenteric angle and distance using computed tomography

Albayrak

Demir²

2017

Cumhuriyet Medical Journal

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SUMMARYObjective: The aim of this study is to evaluate the effect of visceral fat thickness on the distance and angle between the superior mesenteric artery (SMA) and the aorta in the normal population. Method: The aortomesenteric distance and retroperitoneal fat thickness (RFT) were measured on an axial plane, and the aortomesenteric angle and mesenteric fat thickness (MFT) were measured on a sagittal plane using multidetector computed tomography (MDCT). The relationships between MFT, RFT and aortomesenteric angle and distance were evaluated. Results: There was a weak/moderate, significant and positive correlation between aortomesenteric angle and MFT and RFT (r = 0,396, p<0.001 and r = 0,494, p<0.001, respectively). There was also a moderate, significant and positive correlation between aortomesenteric distance and RFT and MFT (r = 0,607, p<0.001 and r = 0,633, p<0.001, respectively). Conclusion:The aortomesenteric distance and angle correlate with the retroperitoneal and mesenteric fat thickness. According to the results, retroperitoneal and mesenteric fat thickness may be used as an CT marker to help diagnose suspected SMAS in addition to the measurements of the aortomesenteric distance and angle. Keywords: Superior mesenteric artery, multidetector computed tomography, mesenteric fat, retroperitoneal fat. ÖZETAmaç: Çalışmamızın amacı, normal populasyonda, visseral yağ doku kalınlığının, superior mezenterik arter (SMA) ile aorta arasındaki açıya ve uzaklığa olan etkisini araştırmaktır. Yöntem: Ölçümler çok kesitli bilgisayarlı tomografi (ÇKBT) cihazı kullanılarak gerçekleştirildi. Aortomezenterik uzaklık ve retroperitoneal yağ doku kalınlığı (RYK) aksiyal kesitlerde, aortomezenterik açı ve mezenterik yağ doku kalınlığı (MYK) sagital kesitlerde ölçüldü. MYK ve RYK ile aortomezenterik açı ve uzaklık arasındaki ilişki araştırıldı. Bulgular: Aortomezenterik açı ile MYK ve RYK arasında sırasıyla zayıf/orta düzeyde pozitif yönlü ilişki tespit edilmiştir (r = 0,396, p<0.001 ve r = 0,494, p<0.001). Aortomezenterik uzaklık ile RYK ve MYK arasında ise orta düzeyde pozitif yönlü bir ilişki tespit edilmiştir (r = 0,607, p<0.001 ve r = 0,633, p<0.001). Sonuç: Aortomesenterik açı ve uzaklık ile visceral yağ doku kalınlıkları arasında pozitif yönlü anlamlı bir ilişki vardır. Bu sonuçlara göre ÇKBT ile ölçülen, retroperitoneal ve mezenterik yağ doku kalınlıkları klinik olarak SMA sendromu düşünülen şüpheli vakaların tanısında aortomezenterik uzaklık ve açı ölçümlerine ek olarak bir BT belirteci olarak kullanılabilir. Anahtar sözcükler: Superior mesenterik arter, çok kesitli bilgisayarlı tomografi, mesenterik yağ dokusu, retroperitoneal yağ dokusu. 676

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Section: Introductionmentioning

confidence: 99%

Assessment of the relationship between intraabdominal fat thickness and the aortomesenteric angle and distance using computed tomography

Albayrak

Demir²

2017

Cumhuriyet Medical Journal

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“…In this case, the conservative treatment allowed the gastroduodenal decompression. In four cases reported, surgery was required [9]. The liberation of the duodenum from its retroperitoneal attachments, including the duodenojejunal flexure, as it was described by Strong [12] in 1958 could be more safely performed than division and reanastomosis of the duodenum [2].…”

Section: Commentmentioning

confidence: 93%

“…Following an ileo anal-pouch anastomosis, the first case is reported by Ballantyne [3] on 1987, and then, only height cases were published to date [2-4,9-11]. The diagnosis is made by the association of vomiting, epigastric pain, and distention, with drainage of abundant gastric and bilious secretions [1,3,9]. Radiological contrast examination and or computed tomography scan are considered to be appropriate for the diagnosis [2,3].…”

Section: Commentmentioning

confidence: 99%

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Superior Mesenteric Artery Syndrome: A Case Report of a Rare Postoperative Complication after Ileal Pouch-anal Anastomosis

Mohamed¹,

Sn²,

He³

et al. 2017

Med Rep Case Stud

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The superior mesenteric artery syndrome following ileal pouch-anal anastomosis after total proctocolectomy is extremely exceptional; a few cases are reported in literature. We report a new case of duodenal compression syndrome by the superior mesenteric artery following a total proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis. The diagnosis was made four days postoperatory by a persistent vomiting and documented by superior digestive tract occlusion showed on computed tomography scan. We attempted a medical treatment that was efficient. The early outcome was good.Keywords: Superior mesenteric artery syndrome; Ileal pouch-anal anastomosis; Proctocolectomy Case ReportA 23 year old patient was diagnosed with familial adenomatous polyposis and was submitted to total proctocolectomy with manual ileal pouch-anal anastomosis by laparotomy. The ileal pouch-anal was performed covered by a protective loop ileostomy. The ileal reservoir down easily to the anal margin without any technical artifice for mesenteric elongation. The tension on the superior mesenteric artery was not considered excessive intraoperatively. On the third postoperative day the patient developed persistent vomiting and epigastric pain and had no passage of gas or liquid through the ileostomy. Perineal examination did not found any sign in favor of pelvic abscess nor pouchitis.A CT of the abdomen revealed large gastric and first duodenal part distension with stasis shown in Figure 1, in contrast with the third part of the duodenum that describes a conical narrowing as it approached the level of the aortomesenteric constriction.These findings supported the clinical diagnosis of superior mesenteric artery syndrome; there was no sign of ischemia in the ileal pouch. He was treated with nasogastric decompression. Drainage diminished slowly and his diet was slowly advanced. He was discharged 15 days following surgery. The early outcome was good. CommentThe superior mesenteric artery syndrome is caused by compression of the third part of the duodenum in the angle between the aorta and the superior mesenteric artery [1,2], Frequently, predisposing medical conditions associated with catabolic states or rapid weight loss result in a decrease of the aortomesenteric angle and subsequent duodenal obstruction [1]. External compression, anatomic variants and surgical alteration of the anatomy following spine surgery or digestive surgery especially, ileoanal pouch anastomosis can also precipitate the syndrome [1,[3][4][5][6]. The occurrence of prolonged postoperative ileus or small bowel obstruction after total proctocolectomy with ileo analpouch anastomosis, as seen in this case, has been reported in 6-25% of patients [7,8], but the involvement of the superior mesenteric artery syndrome was not clearly established. Following an ileo anal-pouch anastomosis, the first case is reported by Ballantyne [3] on 1987, and then, only height cases were published to date [2-4,9-11]. The duodenum was nearly occluded between the superior ...

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“…The movements of duodenum are complicated and the most important movements are reversed peristalsis and direct peristalsis [15][16][17][18] . The direct peristalsis is greater than reversed peristalsis under normal circumstances.…”

Section: Theoretic Basis and Indications For Duodenal Circular Drainamentioning

confidence: 99%

Assessment of duodenal circular drainage in treatment of superior mesenteric artery syndrome

Yang¹,

Zhang²

2008

WJG

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AIM:To assess the clinical value of duodenal circular drainage for superior mesenteric artery syndrome (SMAS). METHODS:Forty-seven cases of SMAS were treated with duodenal circular drainage from 1959 to 2001. Clinical data were analyzed retrospectively. RESULTS:In this group, good effects were achieved in 39 cases treated with duodenal circular drainage after 2-15 years of follow-up. The other eight cases were first treated with anterior repositioning of the duodenum (two cases), duodenojejunostomy (five cases), subtotal gastrectomy and billroth Ⅱ gastrojejunostomy (one case), but vomiting was not relieved until duodenal circular drainage was performed again. A follow-up study of 8-10 years revealed satisfactory results in these eight patients. CONCLUSION:In SMAS, if the reversed peristalsis is strong and continuous, and vomiting occurs frequently, the symptom can not be relieved even if the obstruction of duodenum is removed surgically. The key treatment is the relief of reversed peristalsis. The duodenal circular drainage can resolve the drainage direction of duodenal content, thus relieving the symptom of vomiting.

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Syndrome of duodenal compression by the superior mesenteric artery following restorative proctocolectomy: a case report and review of literature

Abstract: The authors report on a case of this syndrome in a patient with familial adenomatous polyposis and review the literature on the etiopathogenesis, diagnosis, treatment and prevention of this unusual entity.

Cited by 34 publications

References 5 publications

Assessment of the relationship between intraabdominal fat thickness and the aortomesenteric angle and distance using computed tomography

Assessment of the relationship between intraabdominal fat thickness and the aortomesenteric angle and distance using computed tomography

Superior Mesenteric Artery Syndrome: A Case Report of a Rare Postoperative Complication after Ileal Pouch-anal Anastomosis

Assessment of duodenal circular drainage in treatment of superior mesenteric artery syndrome

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