Advances in Diagnosis and Treatment for Superior Mesenteric Artery Syndrome_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Yong , LUO Yuhong.

Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China;

Corresponding author：

Keywords：

Superior mesenteric artery syndrome; Wilkie syndrome; Diagnosis; Treatment

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ObjectiveTo introduce the advances in diagnosis and treatment of superior mesenteric artery syndrome (SMAS). MethodsLiteratures about SMAS published in domestic and abroad were collected and reviewed. ResultsSMAS was a rare medical condition characterized by acute or chronic ileus resulting from vascular compression of the third part of the duodenum by superior mesenteric artery. Images of upper gastrointestinal series, CT, MRI, and color Doppler ultrasonography were the major methods of diagnosing the syndrome and the upper gastrointestinal series was the most important. Conservative approaches were usually preferred to the treatment of SMAS. Surgery was performed on symptomatic patients when conservative treatment failed, and duodenojejunostomy was the best surgical procedure. ConclusionAwareness of the clinical and imaging features may be helpful to diagnosis and treatment of SMAS, and reasonable therapy shall include etiological treatment and relief of the obstruction by conservative treatment or surgery.

Citation： LIU Yong,LUO Yuhong.. Advances in Diagnosis and Treatment for Superior Mesenteric Artery Syndrome. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(2): 225-228. doi: Copy

1.	Rokitansky C. Handbuch der pathologischen Anatomie [M]. Wien, Braunmüller und Seidel, 1842: 187.
2.	Wilkie DPD. Chronic duodenal ileus [J]. Am J Med Sci, 1927, 173: 643649.
3.	雷志盛. 肠系膜上动脉综合征八例误诊分析 [J]. 临床误诊误治, 1998, 11(5): 289.
4.	方立峰, 曾建生. 肠系膜上动脉综合征15例误诊分析 [J]. 胃肠病学和肝病学杂志, 1993, 2(2): 76.
5.	Wayne ER, Burrington JD. Duodenal obstruction by the superior mesenteric artery in children [J]. Surgery, 1972, 72(5): 762768.
6.	Neri S, Signorelli SS, Mondati E, et al. Ultrasound imaging in diagnosis of superior mesenteric artery syndrome [J]. J Intern Med, 2005, 257(4): 346351.
7.	李建伟, 唐宗联, 汪虹. 特大面积烧伤并发肠系膜上动脉压迫综合症1例 [J]. 昆明医学院学报, 2002, 23(4): 99.
8.	Stümpfle R, Wright AR, Walsh J. Superior mesenteric artery syndrome in an HIV positive patient [J]. Sex Transm Infect, 2003, 79(3): 262263.
9.	卢留斌, 崔大勇. HaloVest架致肠系膜上动脉综合征1例 [J]. 实用医药杂志, 2005, 22(9): 846.
10.	Smith BG, HakimZargar M, Thomson JD. Low body mass index: a risk factor for superior mesenteric artery syndrome in adolescents undergoing spinal fusion for scoliosis [J]. J Spinal Disord Tech, 2009, 22(2): 144148.
11.	Goitein D, Gagné DJ, Papasavas PK, et al. Superior mesenteric artery syndrome after laparoscopic RouxenY gastric bypass for morbid obesity [J]. Obes Surg, 2004, 14(7): 10081011.
12.	王元芝, 朱萍, 李风玲. 食管癌术后并发肠系膜上动脉压迫综合症一例 [J]. 实用心脑肺血管病杂志, 2005, 13(4): 240.
13.	AuYong I, Watson NF, Boereboom CL, et al. Endovascular treatment of a Superior Mesenteric Artery Syndrome variant secondary to traumatic pseudoaneurysm [J]. World J Emerg Surg, 2010, 5: 7.
14.	马向涛, 余力伟, 张芳, 等. 表现为急性胃扩张伴胃壁破裂横结肠坏死的肠系膜上动脉综合征 [J]. 中华消化杂志, 2006, 26(7): 472.
15.	Kandil E, Alabbas H, Harbin AC, et al. Superior mesenteric artery syndrome [J]. J La State Med Soc, 2009, 161(5): 285286.
16.	Ko KH, Tsai SH, Yu CY, et al. Unusual complication of superior mesenteric artery syndrome: spontaneous upper gastrointestinal bleeding with hypovolemic shock [J]. J Chin Med Assoc, 2009, 72(1): 4547.
17.	Rod J, Sarnacki S, Petit T, et al. Portal venous gas and thrombosis complicating superior mesenteric artery syndrome (Wilkie’s syndrome) in a child [J]. J Pediatr Surg, 2010, 45(4): 826829.
18.	Tsai CL, Chen MJ, Tan CK, et al. Superior mesenteric artery syndrome with hepatic portal venous gas [J]. Med J Aust, 2007, 186(1): 48.
19.	Konen E, Amitai M, Apter S, et al. CT angiography of superior mesenteric artery syndrome [J]. AJR Am J Roentgenol, 1998, 171(5): 12791281.
20.	方立峰, 王树俊, 胡威, 等. 胃镜检查肠系膜上动脉综合征 [J]. 医药论坛杂志, 2008, 29(8): 5455.
21.	覃峰, 申国光, 龙行安, 等. 肠系膜上动脉综合征误诊漏诊原因分析 [J]. 中国医学影像学杂志, 2003, 11(2): 154.
22.	Mauceri B, Misseri M, Tsami A et al. Ultrasound in diagnosis of superior mesenteric artery syndrome [J]. Clin Ter, 2010, 161(1): 3537.
23.	Sundaram P, Gupte GL, Millar AJ, et al. Endoscopic ultrasound is a useful diagnostic test for superior mesenteric artery syndrome in children [J]. J Pediatr Gastroenterol Nutr, 2007, 45(4): 474476.
24.	Di Matteo F, Picconi F, Sansoni I, et al. Superior mesenteric artery syndrome diagnosed with linear endoscopic ultrasound [J]. Endoscopy, 2010, 42 Suppl 2: E67E68.
25.	唐光佐, 董文广, 黄奕华. 肠系膜上动脉综合征的诊断和治疗（附45例报告） [J]. 中国实用外科杂志, 1995, 15(6): 374375.
26.	蒋红梅, 卢艳如, 陈玉龙. 抗抑郁药对肠系膜上动脉综合征伴抑郁研究 [J]. 医药论坛杂志, 2007, 28(7): 35.
27.	黄建伟, 潘洁, 温凌, 等. 早期肠内营养在肠系膜上动脉综合征中的应用 [J]. 广州医学院学报, 2008, 36(4): 2729.
28.	丁凯, 汪志明, 江志伟. 经PEJ肠内营养在肠系膜上动脉压迫综合征治疗中的作用 [J]. 肠外与肠内营养, 2009, 16(2): 8486.
29.	Biank V, Werlin S. Superior mesenteric artery syndrome in children: a 20year experience [J]. J Pediatr Gastroenterol Nutr, 2006, 42(5): 522525.
30.	Strong EK. Mechanics of arteriomesentric duodenal obstruction and direct surgical attack upon etiology [J]. Ann Surg, 1958, 148(5): 725730.
31.	孙可望, 邹寿椿, 施敦, 等. 肠系膜上动脉综合征21例术式的选择 [J]. 中华普通外科杂志, 2005, 20(1): 1820.
32.	邹小明. 手术治疗肠系膜上动脉综合征的术式探讨 [J]. 中国实用外科杂志, 2006, 26(6): 471472.
33.	陈历恒, 蒋晓忠, 杜一平, 等. 肠系膜上动脉压迫综合征的诊断及术式选择评价 [J]. 中国普外基础与临床杂志, 2008, 15(7): 518521.
34.	Massoud WZ. Laparoscopic management of superior mesenteric artery syndrome [J]. Int Surg, 1995, 80(4): 322327.
35.	Gersin KS, Heniford BT. Laparoscopic duodenojejunostomy for treatment of superior mesenteric artery syndrome [J]. JSLS, 1998, 2(3): 281284.
36.	Munene G, Knab M, Parag B. Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome [J]. Am Surg, 2010, 76(3): 321324.

1. Rokitansky C. Handbuch der pathologischen Anatomie [M]. Wien, Braunmüller und Seidel, 1842: 187.
2. Wilkie DPD. Chronic duodenal ileus [J]. Am J Med Sci, 1927, 173: 643649.
3. 雷志盛. 肠系膜上动脉综合征八例误诊分析 [J]. 临床误诊误治, 1998, 11(5): 289.
4. 方立峰, 曾建生. 肠系膜上动脉综合征15例误诊分析 [J]. 胃肠病学和肝病学杂志, 1993, 2(2): 76.
5. Wayne ER, Burrington JD. Duodenal obstruction by the superior mesenteric artery in children [J]. Surgery, 1972, 72(5): 762768.
6. Neri S, Signorelli SS, Mondati E, et al. Ultrasound imaging in diagnosis of superior mesenteric artery syndrome [J]. J Intern Med, 2005, 257(4): 346351.
7. 李建伟, 唐宗联, 汪虹. 特大面积烧伤并发肠系膜上动脉压迫综合症1例 [J]. 昆明医学院学报, 2002, 23(4): 99.
8. Stümpfle R, Wright AR, Walsh J. Superior mesenteric artery syndrome in an HIV positive patient [J]. Sex Transm Infect, 2003, 79(3): 262263.
9. 卢留斌, 崔大勇. HaloVest架致肠系膜上动脉综合征1例 [J]. 实用医药杂志, 2005, 22(9): 846.
10. Smith BG, HakimZargar M, Thomson JD. Low body mass index: a risk factor for superior mesenteric artery syndrome in adolescents undergoing spinal fusion for scoliosis [J]. J Spinal Disord Tech, 2009, 22(2): 144148.
11. Goitein D, Gagné DJ, Papasavas PK, et al. Superior mesenteric artery syndrome after laparoscopic RouxenY gastric bypass for morbid obesity [J]. Obes Surg, 2004, 14(7): 10081011.
12. 王元芝, 朱萍, 李风玲. 食管癌术后并发肠系膜上动脉压迫综合症一例 [J]. 实用心脑肺血管病杂志, 2005, 13(4): 240.
13. AuYong I, Watson NF, Boereboom CL, et al. Endovascular treatment of a Superior Mesenteric Artery Syndrome variant secondary to traumatic pseudoaneurysm [J]. World J Emerg Surg, 2010, 5: 7.
14. 马向涛, 余力伟, 张芳, 等. 表现为急性胃扩张伴胃壁破裂横结肠坏死的肠系膜上动脉综合征 [J]. 中华消化杂志, 2006, 26(7): 472.
15. Kandil E, Alabbas H, Harbin AC, et al. Superior mesenteric artery syndrome [J]. J La State Med Soc, 2009, 161(5): 285286.
16. Ko KH, Tsai SH, Yu CY, et al. Unusual complication of superior mesenteric artery syndrome: spontaneous upper gastrointestinal bleeding with hypovolemic shock [J]. J Chin Med Assoc, 2009, 72(1): 4547.
17. Rod J, Sarnacki S, Petit T, et al. Portal venous gas and thrombosis complicating superior mesenteric artery syndrome (Wilkie’s syndrome) in a child [J]. J Pediatr Surg, 2010, 45(4): 826829.
18. Tsai CL, Chen MJ, Tan CK, et al. Superior mesenteric artery syndrome with hepatic portal venous gas [J]. Med J Aust, 2007, 186(1): 48.
19. Konen E, Amitai M, Apter S, et al. CT angiography of superior mesenteric artery syndrome [J]. AJR Am J Roentgenol, 1998, 171(5): 12791281.
20. 方立峰, 王树俊, 胡威, 等. 胃镜检查肠系膜上动脉综合征 [J]. 医药论坛杂志, 2008, 29(8): 5455.
21. 覃峰, 申国光, 龙行安, 等. 肠系膜上动脉综合征误诊漏诊原因分析 [J]. 中国医学影像学杂志, 2003, 11(2): 154.
22. Mauceri B, Misseri M, Tsami A et al. Ultrasound in diagnosis of superior mesenteric artery syndrome [J]. Clin Ter, 2010, 161(1): 3537.
23. Sundaram P, Gupte GL, Millar AJ, et al. Endoscopic ultrasound is a useful diagnostic test for superior mesenteric artery syndrome in children [J]. J Pediatr Gastroenterol Nutr, 2007, 45(4): 474476.
24. Di Matteo F, Picconi F, Sansoni I, et al. Superior mesenteric artery syndrome diagnosed with linear endoscopic ultrasound [J]. Endoscopy, 2010, 42 Suppl 2: E67E68.
25. 唐光佐, 董文广, 黄奕华. 肠系膜上动脉综合征的诊断和治疗（附45例报告） [J]. 中国实用外科杂志, 1995, 15(6): 374375.
26. 蒋红梅, 卢艳如, 陈玉龙. 抗抑郁药对肠系膜上动脉综合征伴抑郁研究 [J]. 医药论坛杂志, 2007, 28(7): 35.
27. 黄建伟, 潘洁, 温凌, 等. 早期肠内营养在肠系膜上动脉综合征中的应用 [J]. 广州医学院学报, 2008, 36(4): 2729.
28. 丁凯, 汪志明, 江志伟. 经PEJ肠内营养在肠系膜上动脉压迫综合征治疗中的作用 [J]. 肠外与肠内营养, 2009, 16(2): 8486.
29. Biank V, Werlin S. Superior mesenteric artery syndrome in children: a 20year experience [J]. J Pediatr Gastroenterol Nutr, 2006, 42(5): 522525.
30. Strong EK. Mechanics of arteriomesentric duodenal obstruction and direct surgical attack upon etiology [J]. Ann Surg, 1958, 148(5): 725730.
31. 孙可望, 邹寿椿, 施敦, 等. 肠系膜上动脉综合征21例术式的选择 [J]. 中华普通外科杂志, 2005, 20(1): 1820.
32. 邹小明. 手术治疗肠系膜上动脉综合征的术式探讨 [J]. 中国实用外科杂志, 2006, 26(6): 471472.
33. 陈历恒, 蒋晓忠, 杜一平, 等. 肠系膜上动脉压迫综合征的诊断及术式选择评价 [J]. 中国普外基础与临床杂志, 2008, 15(7): 518521.
34. Massoud WZ. Laparoscopic management of superior mesenteric artery syndrome [J]. Int Surg, 1995, 80(4): 322327.
35. Gersin KS, Heniford BT. Laparoscopic duodenojejunostomy for treatment of superior mesenteric artery syndrome [J]. JSLS, 1998, 2(3): 281284.
36. Munene G, Knab M, Parag B. Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome [J]. Am Surg, 2010, 76(3): 321324.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Advances in Diagnosis and Treatment for Superior Mesenteric Artery Syndrome

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