SMA SYNDROME1x - K.CĐHA - 01-04-2014

SMA SYNDROME1x - K.CĐHA - 01-04-2014 tài liệu, giáo án, bài giảng , luận văn, luận án, đồ án, bài tập lớn về tất cả các...

SMA SYNDROME

SMA SYMDROME

 Duodenal obstruction due to

compression of D3 between the

aorta and the SMA

 Very rare, life-threatening

gastro-vascular disorder

 Aortomesenteric duodenal

compression, Duodenal vascular

compression, Wilkie’s syndrome,

Cast syndrome

• 1842: 1st described by the Austrian

professor Carl von Rokitansky

• 1927: Wilkie published the largest SMA syndrome styde based on 75 cases

• 1989, more than 400 patients with the syndrome had been reported.

• Today: more than 330 articles including case reports, original articles and

reviews

ANATOMY

NUT-CRAKER SYNDROME

SMA SYNDROME

 1 Rapid weight loss

 2 Compression

 3 Mesentaric tension

Table1 Predisposing conditions for development of superior mesenteric artery syndrome

 Following scolisis surgery

 Congentinal anomalities

history of chronic abdominal

complaints with intermittent

exacerbations depending on the cause and grade of duodenal compression

postprandial abdominal pain followed

by vomiting, nausea and anorexia

resulting in weight loss

“Food fear”

Left lateral decubitus or knee-to-chest position

• Symptoms

• Radiological evidence of D3 compression by SMA

• Aorto-mesenteric angle <22 ( normal 38 – 65)

• Aorto-mesenteric distance <8mm (normal 10-28mm)

• Proximal duodenal dilation with cut-off at D3

CASE PRESENTATION

• Nutritional support with

nasojejunal feeds when possible

or TPN in selected patients

• Positioning the patient in a

knee-to-chest position or prone after

eating to improve symptoms

SURGICAL TREATMENT