Small Bowel Adenocarcinoma Simulating Superior Mesenteric Artery Syndrome (SMAS): A Case Report (original) (raw)
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Journal of Cancer Science and Research, 2018
Proximal intestinal obstruction caused by compression of the third part of duodenum between aorta and Superior Mesenteric Artery (SMA) is referred as Superior Mesenteric Artery Syndrome (SMAS). Being a rare and hardly diagnosed entity, we present a 69 year old woman referring with intractable nausea and vomiting, sense of fullness, and weight loss. In upper endoscopy, stomach was distended. Computerized tomography showed a decrease in the angle between aorta and SMA, creating a compression of SMA on duodenum misleading us to SMAS. The patient didn't ease with conservative treatment. Endoscopy is performed with a longer probe for further evaluation and a tumoral mass is found in 3rd and 4th parts of duodenum. It appeared that duodenum tumor blocked the passage, caused weight loss, created SMAS clinic. Positron Emission Tomography-Computed Tomography (PET-CT) exhibited metastasis. The case was inoperable therefore General Surgery Department decided on performing gastrojejunostomy as palliative treatment.
Superior Mesenteric Artery Syndrome: A Forgotten Cause of Duodenal Obstruction
Cureus, 2020
Superior mesenteric artery (SMA) syndrome has been described in medical literature as a rare cause of duodenal occlusion. It has a varied presentation, with distressing gastrointestinal symptoms such as nausea, abdominal pain, and further weight loss. Several conditions contribute to duodenal obstruction in SMA syndrome. We present a case of SMA syndrome in a patient with malignant breast cancer who presented with sudden onset of severe nausea and voluminous vomiting. Various imaging studies revealed a distended proximal intestine with a transition point in the third part of the duodenum. The patient was managed conservatively with nasogastric decompression and fluid electrolyte management, leading to symptomatic relief.
Surgical case reports, 2015
Superior mesenteric artery syndrome (SMAS) after a surgical operation is very rare. We experienced an extremely rare case of ileal pouch-anal anastomosis with subsequent development of SMAS requiring duodenojejunostomy. A 74-year-old Asian woman underwent total colectomy, ileal pouch-anal anastomosis (J-pouch), covering ileostomy, splenectomy, and distal pancreatectomy for treatment of descending colon cancer associated with ulcerative colitis. She complained of abdominal discomfort and vomiting 17 days postoperatively. Computed tomography (CT) revealed fluid collection at the pancreatic stump. We diagnosed a pancreatic fistula and performed CT-guided drainage. SMAS was thereafter diagnosed by contrast-enhanced CT, which revealed a narrow aortomesenteric angle of 36° and short aortomesenteric distance of 2 mm. The SMAS did not respond to conservative therapy. Finally, we performed duodenojejunostomy. This case illustrates that ileal pouch-anal anastomosis might induce relative stret...
International Surgery Journal, 2019
Superior mesenteric artery (SMA) syndrome (also known as Wilkie’s syndrome) is an unusual cause of proximal intestinal obstruction, attributable to vascular compression of the third part of duodenum between the superior mesenteric artery and the abdominal aorta due to acute angulation of SMA. It is a life threatening disease as it poses a diagnostic dilemma and often diagnosed by exclusion of other causes. It is an acquired disorder and is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a case of SMA syndrome in a 23 year young asthenic female patient, with a long history of recurrent abdominal pain, epigastric fullness, voluminous vomiting, and weight loss. Symptoms persisted for 1 year and the patient underwent extensive investigations, but to no avail. Thereafter she developed proximal intestinal obstruction, which unravelled her diagnosis. Abdominal examination revealed epigastric fullness, tenderness and hyper peristaltic bowe...
Superior Mesenteric Artery Syndrome: An Unusual Cause Of Duodenal Obstruction
VITAE Academia …
Superior mesenteric artery (SMA) arising from aorta at the level of first lumbar vertebra usually takes an angular downward course from ventral surface of aorta. It is through this vascular angle that the 3rd part of duodenum passes at the level of 4th lumbar vertebra. Fat and lymphatics around SMA maintains the angle at 25° to 60° with a mean of 45 0 and provide protection against duodenal compression. In Superior Mesenteric Artery Syndrome, the SMA-aorta angle in narrowed down to 7° to 22° with a mean of 8 0 leading to entrapment of the transverse part of duodenum between the artery and the vertebral column and aorta with resultant partial or complete duodenal obstruction. We report a case of Superior Mesenteric Artery Syndrome which was diagnosed by CECT abdomen. Duodeno-jejunostomy was done to treat this condition.
Euroasian Journal of Hepato-Gastroenterology, 2014
A 61-year-old man presented with symptoms of upper gastrointestinal (GI) obstruction, such as postprandial upper abdominal pain, vomiting and weight loss. He was operated for a perforated duodenal ulcer 12 years back. On physical examination, there was mild tenderness over epigastrium. Blood examinations were normal. Typical imaging findings of superior mesenteric artery (SMA) syndrome were demonstrated. Ultrasound examination revealed gastric and duodenal dilatation (Fig. 1). Multidetector computed tomography (MDCT) with multiplanar reconstruction (MPR) revealed aortomesenteric angle (AMA) of <20° and aortomesenteric distance (AMD) from 5 to 8 mm. There was abrupt narrowing of 3rd part of duodenum with dilatation of stomach and proximal duodenum (up to 2nd part) (Figs 2 to 4). Endoscopy revealed two minor benign peptic ulcers but no other cause of duodenal obstruction. Diagnosis of SMA
Superior mesenteric artery syndrome as a rare cause of duodenal obstruction
Surgical Practice, 2007
Superior mesenteric artery syndrome is a rare cause of duodenal obstruction. The syndrome can present as acute small bowel obstruction or intermittent compression symptoms such as postprandial epigastric pain, fullness or vomiting. The obstruction is caused by compression of the third part of the duodenum against the posterior structures by the narrow-angled superior mesenteric artery. The diagnosis is easily confused with gastric outlet obstruction or proximal small bowel obstruction. A high index of clinical suspicion is crucial for diagnosis and computed tomography provides confirmatory evidence. We report two cases of superior mesenteric artery syndrome and a review of the literature for this condition.
A rare cause of duodenal obstruction: Superior mesenteric artery syndrome
International Journal of Case Reports and Images, 2015
International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor.
Superior mesenteric artery compression syndrome - case report
Journal of Coloproctology (Rio de Janeiro), 2011
superior mesenteric artery syndrome is an entity generally caused by the loss of the intervening mesenteric fat pad, resulting in compression of the third portion of the duodenum by the superior mesenteric artery. this article reports the case of a patient with irremovable metastatic adenocarcinoma in the sigmoid colon, that evolved with intense vomiting. Intestinal transit was carried out, which showed important gastric dilation extended until the third portion of the duodenum, compatible with superior mesenteric artery syndrome. Considering the patient's nutritional condition, the medical team opted for the conservative treatment. Four months after the surgery and conservative measures, the patient did not present vomiting after eating, maintaining previous weight. Superior mesenteric artery syndrome is uncommon and can have unspecific symptoms. thus, high suspicion is required for the appropriate clinical adjustment. A barium examination is required to make the diagnosis. the treatment can initially require gastric decompression and hydration, besides reversal of weight loss through adequate nutrition. surgery should be adopted only in case of clinical treatment failure.