2009, Number 3
Syndrome of mesenteric artery superior Two clinical cases in patients tumors
Navarrete-Arellano M, Soto-Fernández AE
Full text
Language: Spanish
References: 5
Page: 119-125
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ABSTRACT
Introduction: syndrome mesenteric artery superior (AMS) is rare, while in 0.2 to 1 percent of radiological studies contrasted of intestinal transit, is produced by obstruction extrinsic of the 3TH portion of the duodenum. The AMS form an acute angle down, the departure of the aorta, the duodenum this behind this angle, and the compressed by the AMS previously, causes symptoms of intestinal obstruction high.Clinical Case 1: Female 9 years without background atopy or perinatal, with abdominal pain from 6 months of evolution, in hipocondrio right, of moderate intensity, exacerbated with food. In recent times comes to emergencies, abdominal pain diagnosing appendicitis, making appendectomy, 2 days after resorts abdominal pain and fever. USG H. and V. B. : reports litiasis vesicular, and one month after performed laparoscopic cholecystectomy. The month and a half presented abdominal pain, located in upper abdomen, intensity 9/10, colicky atypical, without apparent triggers, without accompanying type vomiting, fever, or diarrhea, table repeated in 7 times, treated as ulcerative syndrome.
Performed endoscopy, reporting gastritis mild erosive esophagitis and mild. Abdominal CT contrasted, evidence angle aorto mesenteric 11 degrees, trying nutritional schemes split, however, the patient continued with fullness postprandial immediate and pain in epigastrium triggered by the mouth, joined presents table depressed, planned and carried out duodenoyeyuno anastomosis, moving toward the improvement and graduated. In its last revision has gained 1.7 kg, and attends asymptomatic.
Clinical Case 2: Women 12 years without background atopy, perinatal or pathological. Menarche at age 11, pace catamineal 3-4/28, FUM June 2008 with secondary amenorrhea, Parity 0, Contraception denied.
Entered with 7 months of evolution of abdominal pain, widespread diffuse, intense, intermittent, accompanied by nausea and vomiting, exacerbated by the food intake, receiving treatment with ranitidineand omeprazole, the last two months, introduced anorexia, nausea and reflux gastroesófagico until not tolerate food by feeling of fullness postprandial immediate and dysphagia.
The income had lost 17 kg (6 months), was ruled out hyperthyroidism, and was classified with Malnutrition grade III, without detention of growth, is placed SNG for diet elementary calculated, however withdrew because continued vomiting. As the reports, suggestive data pinch mesenteric, and TAC supports the diagnosis.
It was indicated NPT, maintaining adequate metabolic status and parameters nutritional supplements. We duodenum-jejunum anastomosis, extended toward the improvement and graduated to the 6th day P.O. in your last appointment of control is asymptomatic, and with weight gain of 1 kg.
Discussion: The syndrome of the AMS is rare, with symptoms of digestive tract proximal as epigastric pain, fullness postprandial immediate, nausea, vomiting, dehydration and weight loss. The studies confirmatory are x-rays simple, AS, TAC and the endoscopy high, once diagnosed the treatment is surgical and existing alternatives the shunt duodenojejunal is the best.
In this context our patients presented data compatible with their diagnosis, and carried out the image studies, evidencing angle aorto mesenteric, less than 12 degrees in both cases, were applied the maneuvers medical to maintain a proper caloric-proteíco oral, however did not obtain success, so it was scheduled surgery, type duodenum-yeyunoanastomosis.
Postintervention, patients developed toward the improvement, and graduated with proper oral tolerance. Now both with weight gain.
REFERENCES