Superior Mesenteric Artery Syndrome; A rare cause of duodenal obstruction: Report of two cases
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CASE REPORT
Superior Mesenteric Artery Syndrome; A Rare Cause of Duodenal Obstruction: Report of Two Cases Najmus Saadat Jamadar, Nisith Chandra Karmakar, Himansu Roy
Abstract Aim: To report two cases of Superior Mesenteric Artery Syndrome (SMAS) with some abnormal anatomical findings. Case Report: Two patients with bizarre abdominal symptoms indicating gastric outlet obstruction, which came out
to be a rare case Superior mesenteric artery syndrome with some anatomical aberrations. Result: With a clinical and radiologically confirmed diagnosis of Superior Mesenteric Artery Syndrome (SMAS),
both cases underwent uneventful recovery after definitive surgical treatment. Conclusion: This rare diagnosis of Superior Mesenteric Artery Syndrome (SMAS) is based mostly on clinical symptoms
and radiologic evidence of duodenal obstruction by Barium studies and abdominal CT scan. Along with compression of third part of duodenum, altered relationship of superior mesenteric vein and artery with high up cecum and sub-hepatic location of appendix and mesenteric vascular abnormality sometimes do coexist, as we encountered in our cases. Presently, surgical treatment (either laparoscopic or open) is the only accepted way of managing SMAS. Key words: Superior mesenteric artery syndrome; duodenal obstruction; high up caecum; prophylactic appendicectomy;
saccular dilation
Introduction Superior Mesenteric Artery (SMA) Syndrome is a rare disorder, in which acute angulation of SMA causes compression of the third part of the duodenum between the SMA and the aorta, leading to obstruction. We report two cases with bizarre abdominal symptoms indicating gastric outlet obstruction, which came out to be a rare case of Superior Mesenteric Artery Syndrome.
Case report 1 A 14 year young boy admitted with a complaint of recurrent abdominal pain, epigastric fullness, vomiting and Najmus Saadat Jamadar M.S. (General Surgery), Residential Medical Officer Cum Clinical Tutor, Calcutta Medical College Nisith Chandra Karmakar M.S. (General Surgery), Professor of Surgery, Nilratan Sircar Medical College Himansu Roy M.S. (General Surgery), Associate Professor, Dept. of General Surgery, Calcutta Medical College 4. Dr. Saswati Das, M.D.(Dermatology,Venereology and Leprosy), Consultant Dermatologist, B.N.R. Hospital, Kolkata Corresponding author: Dr. Najmus Saadat Jamadar M.S (General Surgery), Residential Medical Officer Cum Clinical Tutor, Calcutta Medical College e-mail: [email protected] Received 15 June 2016; Accepted 30 July 2016 Hellenic Journal of Surgery 88
weight loss. Pain was colicky in nature and was precipitating by eating food and relieved after bouts of vomiting. Abdominal examination revealed epigastric fullness and hyper peristaltic bowel sounds. Routine blood and urine examination were normal. Mantoux and erythrocyte sedimentation rate (ESR) test were negative. Ultrasonography (USG) of the abdomen was insignificant. Upper gastrointestinal barium study showed dilated stomach with dilated second part of the duodenum and cut off at the
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