González-Mondragón MB, Granados-Navas FJ, Herrera-García W

Language: Spanish
References: 12
Page: 244-247
PDF size: 1653.12 Kb.

ABSTRACT

Introduction: Superior mesenteric artery (SMA) syndrome is characterized by postprandial epigrastic pain, vomit, nausea, anorexia and weight loss. These symptoms results from the compression of the third portion of the duodenum at the angle between the abdominal aorta and the superior mesenteric artery. We report the case of a child with SMAS who had lost weight owing to abdominal tuberculosis.
Case report: A 10 year-old boy had been ill for a month with weight loss, gastrobillious vomiting and signs of bowel obstruction. He was admitted in a regional hospital where a laparatomy and a jejunostomy were performed. A lymph node biopsy indicated abdominal tuberculosis.
The patient was referred to the INP where an esophagus gastrodudenal series and angiotomography were done. They showed gastric dilatation and total obstruction of the third portion of de duodenum with a decrease of the aortomesenteric angle. He was given parenteral nutrition for 2 months without weight increase. Another surgical procedure was done consisting of a lateral-lateral duodenum-jejuno anastomosis. The patient began enteral feeding 7 days postoperatively. He had a satisfactory course and recovered 6 kg in 2 months.
Discussion: Currently, there are two options for the management of patients with SMAS: a nutritional treatment or a surgical procedure. In our case after the failure of the nutritional treatment, surgery was the indicated option.
A cost-benefit analysis, indicates that the surgical treatment was the best option. Keeping in mind the socio-economical status of our population, this option reduces days of hospitalization as opposed to the high cost of parenteral nutrition. Surgical treatment allows early enteral nutrition and an earlier the return of the patient to his family environment.

REFERENCES

1. Biank V, Werlin S. Superior mesenteric artery syndrome in children: A 20- year experience. J Pediat Gastroenterol Nutr 2006;42:522-5.

2. Welsch T, Büchler M, Kienle P. Recalling superior mesenteric artery syndrome. Diag Surg 2007;24:149-56.

3. Jawad NH, Al-Sanae A, Qabandi W. Superior mesenteric artery syndrome: An uncommon cause of intestinal obstruccion; Report of two cases and review of literature. Kuwait Medical J 2006;38:241-4.

4. Burrington JD. Superior mesenteric artery syndrome in children. Am J Dis Child 1976;130:1367-70

5. Wayne ER, Burrington JD. Duodenal obstrucción by the superior mesenteric artery in children. Surgery 1972;762-8.

6. Mansberger AR Jr, et al. Vascular compression of the duodenum. Emphasis on accurate diagnosis. Am J Surg 1968;115:89-96.

7. Birsen Unal, et al. Superior mesenteric artery syndrome: CT and ultrasonography findings. Diag Interv Radiol 2005;11:90-5.

8. Lippl F, Hanning C, Weib W, et al. Superior artery syndrome: diagnosis and treatment form the gastroenterologist´s view. J Gastroenterol 2002;37:640-3.

9. Delgadillo X, Belpaire-Dethiou MC, Chantrain C, et al. Arteriomesenteric syndrome as a cause of duodenal obstruccion in children with cerebral palsy. J Pediatric Surg 1997;32:1721-3.

10. Lippl f, Hannig C, et al. Superior mesenteric artery syndrome: diagnosis and treatment from the gastroenterologist,s view. J Gastroenterol 2002;37:640-3.

11. Cohen LB, et al. The superior mesenteric artery syndrome. The disease that isn´t or is it? J Clin Gastroenterol 1985;7:113-6.

12. Hines JR, et al. Superior mesenteric artery syndrome. Diagnostic criteria and therapeutic approaches. Am J Surg 1984;148:630-2.