ABSTRACT
Superior mesenteric artery syndrome (SMAS) is an uncommon cause of high intestinal obstruction in neonates; it is owing to incomplete obstruction in the third part of the duodenum caused by compression between the SMA and abdominal aorta. In neonates, complete intestinal obstruction owing to SMAS has been very rarely reported in the literature .We present a 7-day-old previously healthy male infant with a short history of gastroenteritis and sepsis followed by progressive abdominal distension and persistent bilious vomiting that resulted in hypovolemic shock. The patient was aggressively resuscitated, and a gastrografin study showed a hugely distended stomach with an abrupt narrowing at the third part of the duodenum. Exploratory laparotomy unexpectedly revealed a high insertion of the duodenum at the ligament of Treitz, with upward displacement and SMA compression leading to duodenal obstruction. The ligament of Treitz was divided, and the duodenum, mobilized. The postoperative course was uneventful. Although extremely rare, SMAS should be considered as one of the differential diagnoses in newborns presenting with complete intestinal obstruction, especially if preceded by gastroenteritis or sepsis-like symptoms.
Subject(s)
Intestinal Obstruction/etiology , Superior Mesenteric Artery Syndrome/congenital , Diagnosis, Differential , Gastroenteritis/complications , Humans , Infant, Newborn , Laparotomy , Ligaments/surgery , Male , Shock/diagnosis , Shock/etiology , Shock, Septic/diagnosis , Superior Mesenteric Artery Syndrome/surgery , Vomiting/etiologyABSTRACT
We describe a case of a 10 yr old boy, who suffered from gastroesophageal reflux in the neonatal period and from recurrent abdominal pain, epigastric distension and vomiting since birth, but with an increase in this clinic in the last two years, especially in the last five months, without suffering weight loss, having operations or other illnesses. After the diagnosis of superior mesenteric artery syndrome was confirmed by a superior barium series and a CT-scan, a laparotomy was performed, carrying out the Koecher manoeuvre, cutting the Treitz ligament near of the 4th part of the duodenum until descend that and freeing the aorto-mesenteric space. The follow up after 5 years showed an excellent clinical evolution. In our opinion, this case should be considered to be of congenital origin, but without other associated abdominal anomalies. The possible different interventions are also discussed.
Subject(s)
Superior Mesenteric Artery Syndrome/congenital , Child , Humans , Male , Radiography , Superior Mesenteric Artery Syndrome/diagnostic imaging , Superior Mesenteric Artery Syndrome/surgeryABSTRACT
Se trata de un chico de 10 años de edad, con antecedentes de reflujo astro-esofágico (RGE) del lactante muy prolongado y que continuó desde los dos años de edad con crisis de dolor abdominal intermitente localizado en epigastrio y acompañado de distensión y vómitos. Esta clínica fue progresivamente en aumento, especialmente en los últimos cinco meses, aunque sin haber sufrido pérdida de peso ni otros trastornos o intervenciones quirúrgicas. Tras confirmarse el síndrome de la arteria mesentérica superior (SAMS) mediante un tránsito digestivo superior y TAC con contraste, le practicamos una laparotomía, seguida de la maniobra de Koecher, sección del ligamento de Treitz en la cuarta porción del duodeno, liberación de este espacio retroperitoneal y descenso del duodeno. Tras 5 años de seguimiento clínico, la evolución clínica es excelente, así como los hallazgos radiológicos. En nuestra opinión, este caso del debatido SAMS puede considerarse de origen congénito, por la edad, la clínica en ausencia de pérdida de peso y de otras anomalías congénitas asociadas. Discutimos las diferentes opciones terapéuticas y recomendamos la intervención quirúrgica practicada para los casos similares (AU)
We describe a case of a 10 yr old boy, who suffered from gastroesophagealreflux in the neonatal period and from recurrent abdominal pain, epigastric distension and vomiting since birth, but with an increase in this clinic in the last two years, especially in the last five months, without suffering weight loss, having operations or other illnesses. After the diagnosis of superior mesenteric artery syndrome was confirmed by a superior barium series and a CT-scan, a laparotomy was performed, carrying out the Koecher manoeuvre, cutting the Treitz ligament near of the 4th part of the duodenum until descend that and freeing the aorto-mesenteric space. The follow up after 5 years showed an excellent clinical evolution. In our opinion, this case should be considered to be of congenital origin, but without other associated abdominal anomalies. The possible different interventions are also discussed (AU)
Subject(s)
Humans , Male , Child , Superior Mesenteric Artery Syndrome/congenital , Superior Mesenteric Artery Syndrome/complications , Superior Mesenteric Artery Syndrome/diagnosis , Gastroesophageal Reflux/complications , Laparotomy/methods , Abdominal Pain/complications , Abdominal Pain/etiology , Cumulative Trauma Disorders/complications , Vomiting/complicationsABSTRACT
Intestinal obstruction is not a rarity in the newborn. Its etiology is diverse. Superior mesenteric artery syndrome (SMAS) is a phenomenon in which the duodenum is obstructed by the SMA. This causes bowel obstruction accompanied by duodenal dilatation. It has previously been described in adults and children but rarely in infants. We report for the first time on an intrauterine manifestation of SMAS.
