1/5. superior mesenteric artery syndrome in children.superior mesenteric artery syndrome is an uncommon clinical condition characterised by features of acute or chronic upper gastrointestinal tract obstruction. It sometimes has particular clinical associations such as weight loss, spinal surgery cast application or adhesions. Associated multiple clinical problems can complicate the picture and delay diagnosis. diagnosis is usually by barium meal showing compression of the 3rd part of duodenum. Treatment can be conservative or surgical. Surgical treatment consists of division of the ligament of Treitz and derotation of the gut. We review our experience of four children with this syndrome.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/5. The superior mesenteric artery syndrome. The disease that isn't, or is it?intestinal obstruction of the duodenum by entrapment between the aorta and the superior mesenteric artery (SMA) is an uncommon cause of megaduodenum. Despite many case reports, acceptance of the SMA syndrome as a clinical entity has been controversial on account of its confusion with other causes of megaduodenum. We therefore report a case of SMA syndrome which sharply exemplifies its clinical and anatomic features. The clinical findings are proximal duodenal obstruction with an abrupt cutoff and active peristalsis. The anatomic features of this entity are a narrow angle between the aorta and the SMA, together with high fixation of the duodenum by the ligament of Treitz and/or an anomalous SMA crossing directly over the aorta at its intersection with the duodenum. The SMA syndrome may occur as an acute self-limited event due to a reversible precipitating factor, or as a chronic recurring disorder. The acute form subsides with correction of the specific initiating factor; the chronic form responds favorably to simple surgical mobilization of the duodenum.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
3/5. superior mesenteric artery syndrome:--report of four cases.Four patients of SMA syndrome presented in the past 3 years. One case was treated surgically and three others were treated conservatively. Although it is rare, strong suspicion is advocated in evaluating patients with long-standing vague abdominal complaints. diagnosis is made by upper gastrointestinal barium study and SMA angiogram. However, mild distention of the duodenum may be overlooked in barium meal G.I. series. The air inflation test has been of value in recognizing this syndrome. It has been recognized that there are acute and chronic forms. peptic ulcer is often associated with SMA syndrome, especially in the chronic form. Conservative treatment must be stressed and performed initially. Surgical intervention is indicated if medical treatment fails. Division of the ligament of Treiz to free the bound position of the duodenum and make the duodenojejunal flexure downward is advocated first during surgery. If the result is not satisfactory the duodenojejunostomy is necessary.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
4/5. superior mesenteric artery syndrome in a tube-fed patient.Obstruction resulting from superior mesenteric artery syndrome is not often considered a possible cause for gastrostomy-tube complications in tube-fed patients. This case report details our experience with a patient who had had a feeding gastrostomy tube in place for 2 years. She then developed continuous leakage around the area of the gastrostomy insertion site associated with pain and inability to tolerate feedings. Her gastrointestinal series revealed compression of the third portion of the duodenum with delayed emptying of the stomach and dilatation of the proximal duodenum. After resection of the necrotic gastrostomy site, takedown of the ligament of Treitz to free the fourth portion of the duodenum, and insertion of a feeding jejunostomy, the patient was again able to gain weight and tolerate her tube feedings. We present this as an unusual complication occurring in a tube-fed patient.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
5/5. Laparoscopic duodenojejunostomy for treatment of superior mesenteric artery syndrome.BACKGROUND AND OBJECTIVES: Superior mesenteric artery (SMA) syndrome is a rare disorder, recognized as weight loss, nausea, vomiting, and post-prandial pain due to compression and partial obstruction of the third portion of the duodenum by the SMA. If conservative treatment fails, then laparotomy with duodenojejunostomy or lysis of the ligament of Treitz is indicated. Recently, laparoscopic division of the retroperitoneal attachments of the duodenum has been described. We report the first case of laparoscopic duodenojejunostomy as the definitive treatment of vascular compression of the duodenum. methods: A very thin woman with a diagnosis of SMA syndrome was prepared for surgery after having failed medical therapy. The patient was placed in a supine position, and four laparoscopic ports were required to perform a 5 cm duodenojejunostomy. RESULTS: The patient did well postoperatively. A gastrograffin study revealed no leak with patency of the duodenojejunal anastomosis. She was subsequently discharged home on a regular diet on postoperative day four. CONCLUSION: Laparoscopic duodenojejunostomy is a viable option to treat vascular compression of the duodenum. It provides definitive treatment while preserving the benefits of minimally invasive surgical techniques in the debilitated patient.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |