ABSTRACT
Introducción: El Síndrome de la Arteria Mesentérica Superior es causa poco frecuente de obstrucción duodenal. Los síntomas varían desde una obstrucción leve hasta emergencias agudas. El examen físico no siempre ayuda al diagnóstico, que se basa en los hallazgos imagenológicos. Objetivo: preconizar, recomendar el uso de las técnicas mínimamente invasivas en el manejo quirúrgico del Síndrome de la Arteria Mesentérica Superior. Presentación del caso: Mujer de 49 años de edad, antecedentes de pérdida de peso después de quimioterapia con náuseas, vómitos y dolor abdominal posprandial de dos años de evolución. Tratada exitosamente con duodenoyeyunostomía laparoscópica. El tratamiento inicial suele ser conservador. Publicaciones recientes respaldan que la duodenoyeyunostomía laparoscópica es un método seguro y efectivo para su tratamiento. Conclusiones: El tratamiento quirúrgico es cada vez más exitoso, la mayoría de los pacientes no presenta síntomas después de la cirugía(AU)
Introduction: Superior Mesenteric Artery Syndrome is an uncommon cause of duodenal obstruction. Symptoms may vary from mild obstruction to acute life-threatening emergencies. Physical examination does not always help in establishing the diagnosis which is based on findings from imaging studies. Objective: To recommend the laparoscopic approach for the surgical treatment of this entity. Case presentation: A 49-year old female patient with prior history of weight loss after chemotherapy and a two-year history of postprandial nausea, vomiting, and abdominal pain who was successfully treated by laparoscopic duodenojejunostomy is presented. Discussion: Initial treatment is usually conservative. Recently published studies support that laparoscopic duodenojejunostomy is a safe and effective method of treatment. Conclusions: Surgical treatment is becoming more successful and the majority of patients are symptom-free after surgery(AU)
Subject(s)
Female , Middle Aged , Superior Mesenteric Artery Syndrome/therapy , Abdominal Pain , Drug Therapy , Duodenal Obstruction/complications , Weight Loss , Duodenoscopy/methodsABSTRACT
A maior parte dos artigos sobre obstrução duodenal após cirurgia aórtica cita dados referentes às correções da doença aneurismática e não da doença aterosclerótica. Não obstante, é consenso que se trata de uma complicação rara, cuja incidência é menor do que 1 por cento. Os autores relatam o caso de um paciente submetido a enxerto aorto-bifemoral que apresentou, como complicação pós-operatória, oclusão duodenal. O paciente foi tratado com reintervenção cirúrgica e uso de remendo de grande omento para síntese do retroperitônio. A revisão da literatura indica que a maioria dos casos responde bem ao tratamento conservador, e a conduta cirúrgica normalmente só é necessária quando aderências são a causa da obstrução ou quando o tratamento clínico não é satisfatório após 2 semanas.
Most articles on duodenal obstruction following aortic surgery report data relative to repairs of aneurysmal disease, not atherosclerotic disease. However, duodenal obstruction is an uncommon complication, occurring in less than 1 percent of patients. We report a case of a patient submitted to aortobifemoral bypass reconstruction who had duodenal obstruction as postoperative complication. The patient was treated with surgical intervention and omental patching for retroperitoneal synthesis. Literature review indicates that most cases respond well to the conservative treatment, and surgical conduct is usually only required when adherences are causing the obstruction or when clinical treatment is not satisfactory after 2 weeks.
Subject(s)
Humans , Male , Middle Aged , Aorta, Abdominal/surgery , Aorta/surgery , Aorta/injuries , Duodenal Obstruction/surgery , Duodenal Obstruction/complicationsABSTRACT
El páncreas anular es una malformación congénita, infrecuente, de importancia médica porque puede ocasionar obstrucción del duodeno, ya sea completa (atresia) o parcial (estenosis), de tal manera que las manifestaciones clínicas dependen del grado de obstrucción del duodeno. Se informa tres casos de pacientes con páncreas anular, con antecedente de Síndrome de Down, operados en el Hospital de Especialidades del Instituto Hondureño de Seguridad Social de Tegucigalpa. El diagnóstico se confirmó a través de estudios radiológicos. Se les realizó duodenoduodenoanastomosis, en forma exitosa. No existen reportes previos publicados en la literatura médica hondureña...
Subject(s)
Humans , Male , Child, Preschool , Congenital Abnormalities , Duodenal Obstruction/complications , Pancreas , Duodenostomy , Down Syndrome/complicationsABSTRACT
Superior mesenteric artery (SMA) syndrome is a condition where compression of the duodenum between the root of the SMA and the aorta results in intermittent obstruction of the third part of duodenum. Portal venous gas associated with nonischemic bowel is uncommon. We report an 81-year-old man who developed gastric pneumatosis and hepatoportal venous gas due to SMA syndrome, which healed without any sequelae.
Subject(s)
Aged, 80 and over , Duodenal Obstruction/complications , Gastric Dilatation/etiology , Humans , Laparotomy , Male , Portal Vein/pathology , Superior Mesenteric Artery Syndrome/complications , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Retroperitoneal fibrosis is a rare disease characterized by the formation of dense plaque of fibrous tissue covering the retroperitoneal structures. This disease is commonly presented as ureteral obstruction, but the involvement of duodenum is rare. We report a case of retroperitoneal fibrosis which was complicated with duodenal stenosis and was successfully treated with corticosteroids. A 58-yr-old man, who had history of aorto-iliac bypass graft due to arteriosclerosis obliterans with infrarenal aortic occlusion was admitted to the hospital with abdominal pain and a mass. Abdominal CT scan revealed the periaortic soft tissue mass encircling grafted aorta and stenosis of duodenal third portion. Retroperitoneal fibrosis with duodenal stenosis was diagnosed and prednisolone therapy was initiated. Follow-up CT scan showed that the patient responded to prednisolone therapy with eased pain, shrinking periaortic mass, and reduced duodenal stenosis.
Subject(s)
Humans , Male , Anti-Inflammatory Agents/therapeutic use , Duodenal Obstruction/complications , Glucocorticoids/therapeutic use , Middle Aged , Prednisolone/therapeutic use , Retroperitoneal Fibrosis/complications , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
La obstrucción duodenal por un aneurisma de aorta abdominal es un hallazgo infrecuente. Se reporta un caso de obstrucción de la tercera porción duodenal producida por un gran aneurisma de la aorta abdominal. A diferencia de otros casos reportados, donde el aneurisma produce disminución del ángulo de salida de la arteria mesentérica superior, produciendo obstrucción de la tercera porción del duodeno, en el caso presentado se muestra claramente que la obstrucción es provocada por el aneurisma aórtico y no por la arteria mesentérica superior
Subject(s)
Humans , Male , Aged , Aortic Aneurysm, Abdominal/complications , Duodenal Obstruction/etiology , Abdominal Pain , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Abdominal/epidemiology , Duodenal Obstruction/complications , VomitingABSTRACT
Se presenta un caso de Atresia de Esófago con Fístula Traqueoesofágica Inferior (Tipo III de la clasificación de Gross), que presentó como malformación congénita asociada Obstrucción Duodenal por Páncreas Anular, a quien no se pudo realizar anostomosis esofágica primaria por separación importante entre ambos segmentos esofágicos, practicándose en el primer tiempo quirurugico Ligadura de Fístula Traqueoesofágica Inferior, Duodenoduodenoanastomosis laterolateral en forma de Diamante más Gastrostomía. En un segundo tiempo quirurgico, a los tres meses de edad, se practica Anastomosis Esofágica, presentando como complicación postoperatoria, perforación esofágica por encima de la anastomosis, que requirió reintervención quirúrgica, alimentación parenteral y tratamiento con Anfotericina por presentar Cultivos de Hongos positivos para Cándida albicans. Actualmente paciente en buenas condiciones tolerando adecuadamente vía oral. Se analizan las Malformaciones Congénitas más frecuentes asociadas a al Atresia de Esófago y las complicaciones postoperatorias, sus causas y manejo
Subject(s)
Infant, Newborn , Humans , Male , Female , Anastomosis, Surgical , Esophageal Atresia/complications , Esophageal Atresia/diagnosis , Esophageal Atresia/surgery , Digestive System Abnormalities , Tracheoesophageal Fistula/congenital , Duodenal Obstruction/complications , Duodenal Obstruction/congenital , Duodenal Obstruction/surgery , Tracheoesophageal Fistula , Esophageal PerforationABSTRACT
A study of 23 neonates with congenital duodenal obstruction is reported. Their mean gestational age was 38 weeks and mean weight was 2.2 kg. Main clinical features observed were vomiting (100%), which was bilious in 74%, and epigastric fullness with visible peristalsis (74%). Plain X-ray abdomen confirmed the diagnosis in 78%. Associated congenital malformations were seen in 39% of cases. Eleven babies had an intrinsic defect, 11 had extrinsic defect and one baby had combination of intrinsic and extrinsic defect. Malrotations along with band was seen in 39% of cases. Reported mortality was 39%.