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SUPERIOR MESENTERIC ARTERY SYNDROME.pptx
- 1. SUPERIOR MESENTERIC ARTERYSYNDROME: CASE REPORT
- 2. Abstract : • Superiormesenteric artery syndrome is a life- threatening upper gastrointestinal disorder in tall and thin build teenages and adults due to compression of duodenum as it poses a difficult diagnostic dilemma. Third part of duodenum is in fixed compartment bounded anteriorly by the root of mesentery and superior mesentery artery and posteriorly by the aorta and lumbar spine. On barium contrast study and abdominal computerized tomography (CT) showed the dilatation of second part of duodenum and compression of the third part of duodenum between aorta and superior mesentery artery.
- 3. Case report : •A 17 yrs/m young patient resident of Nagpur ,Maharashtra, student by occupation Hindu by religion came to paediatric surgery opd with complains of pain in abdomen since 1 day • Patient was apparently alright before a day back when he started experiencing generalized pain in abdomen ( intermittent , dull aching , non radiating ) with no aggravating or relieving factors. • He had h/o 4-5 episodes of non projectile , non bilious vomiting • No h/o trauma • No h/o/ fever • No h/o hard stools / constipation • No h/o burning micturition • No h/o similar complains in past • H/o open appendicetomy done 5 yrs back • No h/o DM/TB/BA/HYPERTENSION
- 4. • General examination: patient is conscious , co-operative and oriented to time/place and person • Patient had thin build and normal gait • Afebrile to touch • Pulse- 80/min • Bp-110/70 mmhg • Respiratory rate- 14/min’ • Patient has no pallor , icterus, cynosis, clubbing ,lymphadenopathy
- 5. • Systemic examination CVS– S1S2 – Heard, no murmur CNS – conscious, oriented to time/place/person RS - Air entry bilaterally equal • PER ABDOMEN - • Inspection – Skin over abdomen normal Shape – scaphoid Umbilicus- inverted No e/o dilated veins No distension
- 6. • Palpation- Abdomen issoft, nontender No guarding , no rigidity No organomegaly No palpable lump • Auscultation – bowel sounds heard all 4 quadrants of abdomen • Percussion – Tympanic note present all over abdomen
- 7. • Investigations : •CBC- LFT- HB T.bili- TLC Indirect bili - PLT Direct bili- • KFT S.albumin Urea – S.globulin S.creat - Total proteins Na- SGOT K- SGPT
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- 9. MANAGEMENT: • The clinicalsymptoms and signs with investigative findings suggested the diagnosis of SMAS. Conservative treatment was tried for 15 days. The patient was told to take frequent small meals of nutritious liquid, advised to lie on left side/prone following meals. Metaclopramide was also advised but no relief of symptoms found, so surgery was planned. • Exploratory laparotomy through a midline incision was done. Intra-operative findings confirmed the extrinsic obstruction of third part of duodenum with distension of 2nd part. Peritoneal adhesions also present. The site of obstruction was further confirmed by nosogastic air-insufflations. Adhesions were separated. A retrocolic duodenojejunostomy, side to side anastomosis done. In post-operative follow up, patient was symptom free and started taking normal diet and added some weight.