Superior mesenteric artery syndrome following ileal J-pouch anal anastomosis

Abstract

This is the first case report of the superior mesenteric artery syndrome developing in a patient following total proctocolectomy and ileal J-pouch anal anastomosis. In addition, this is the first demonstration of this syndrome using abdominal CT scan. A 22-year-old veteran underwent total proctocolectomy for left-sided ulcerative colitis because of failure of medical therapy. At operation an ileal J-pouch anal anastomosis was constructed. Following operation, the patient developed an intestinal obstruction. Abdominal CT scan demonstrated scant retroperitoneal fatty tissue, massive dilatation of the duodenum proximal to the midline, and tapered narrowing of the duodenum between the superior mesenteric artery and aorta. These findings indicated superior mesenteric artery syndrome: arteriomesenteric obstruction of the duodenum. Based on the experience of this case, the authors believe that compression of the duodenum by the superior mesenteric artery may be a common but unsuspected cause of prolonged postoperative ileus or early postoperative obstruction following ileal pouch anal anastomosis.

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

“…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]. CT demonstrate the location of the obstruction that occurs between the aorta and the superior mesenteric artery as observed in the present case (Figures 1 and 2), and it also contributes to wards the diagnosis of other postoperative intestinal obstruction.…”

“…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.…”

“…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 diagnosis is made by the association of vomiting, epigastric pain, and distention, with drainage of abundant gastric and bilious secretions [1,3,9].…”

“…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].…”

Superior Mesenteric Artery Syndrome Following Correction of Kyphosis in an Adult

“…2,[8][9][10][11] It has also been described in patients in spica casts for hip or spinal disease 3,12,13 or following the surgical correction of spinal deformities, most commonly scoliosis. 2,3,11,12,[14][15][16][17][18][19][20][21] Willett 22 was the first to describe the "cast syndrome" in a patient with kyphosis treated by the application of a body cast in 1878. To date, four cases of SMA syndrome resulting from the surgical correction of kyphosis have been reported in the English literature, all of which were adolescents.…”