복강경을 이용하여 치료한 상장간막 동맥 증후군 1예
A Case of Superior Mesenteric Artery Syndrome Treated by Laparoscopic Surgery
0
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
상장간막 동맥 증후군(superior mesenteric artery syndrome)은 십이지장의 제3부위가 상장간막 동맥의 기시부에서 장간막에 의해 압박되면서 나타나는 질환이다. 임상적으로 급성인 형태로 나타나기도 하지만 대부분은 만성적으로 나타나기도 한다. 진단은 비교적 쉽지 않아 대부분 다른 질환들을 배제함으로써 확인하게 된다. 저자 등은 최근에 심한 체중 감소와 함께 식후 복부 팽만감과 구역, 담즙이 섞인 구토를 주소로 내원한 환자에서 복부 초음파와 MR-angiography를 실시하여 aorto-mesenteric angle과 aorto-mesenteric distance를 측정함으로써 상장간막 동맥 증후군으로 진단하였고, 복강경을 이용하여 Treitz 인대를 분할하고 십이지장을 하방 전이시켰다. 이후 환자는 증상이 호전되었다. 상부위장관 폐쇄가 있을 경우에 상장간막 동맥 증후군도 하나의 원인으로 고려해야 할 것이고, 이에 문헌 고찰과 함께 보고하는 바이다.
Abstract
Superior mesenteric artery (SMA) syndrome is a symptom complex resulting from compression of third portion of duodenum by the root of the small bowel mesentery at the level of the SMA. This syndrome can occur as an acute illness but more commonly it appears as chronic condition. Identification of this syndrome can be a diagnostic dilemma and it is frequently made by exclusion. In our patient, rapid weight loss, nausea and bile stained vomiting were present. Ultrasound and MR-angiography were performed for measuring the angle and the distance between the SMA and the aorta. We confirmed the diagnosis via the reduced aorto-mesenteric angle and distance and the patient was then treated by laparoscopic surgery. After lysis of the ligament of Treitz, the patient's symptom were improved. This syndrome must be considered as one of the causes of upper gastrointestinal obstruction. (Korean J Gastrointest Endosc 2006;32:215-220)
참고문헌 (20)
- "Chronic duodenal ileus due to chronic arteriomesenteric occlusion;report of case", 73, pp.1022~1025 (1956), AMA Arch Surg
- "Intermittent arteriomesenteric occlusion of the duodenum", 67, pp.729~737 (1956)
- "Vascular compression of the duodenum", 117, pp.103~118 (1963)
- "Diagnosis and treatment of superior mesenteric artery syndrome", 71, pp.499~501 (1984)
- "Superior mesenteric artery syndrome presenting with acute massive gastric dilatation", 32, pp.1801~1803 (1997)
- "Superior mesenteric artery syndrome:diagnostic criteria and therapeutic approaches", 148, pp.630~634 (1984)
- "Superior mesenteric artery syndrome:a follow up study pf 16 operated patients", 11, pp.386~391 (1989)
- "Duodenal compression caused by superior mesenteric artery", 9, pp.480~484 (2003)
- "The superior mesenteric artery syndrome", 31, pp.175~178 (1986)
- "Ultrasound imaging in diagnosis of superior mesenteric artery syndrome", 257, pp.346~351 (2005)
- "Vascular compression of the duodenum:presentation of ten cases and review of the literature", 79, pp.515~522 (1976)
- "Vascular compression of the duodenum.Emphasis on accurate diagnosis", 115, pp.89~96 (1968)
- "Diagnostic value of hypotonic duodenography in superior mesenteric artery syndrome", 144, pp.39~43 (1978)
- "CT angiography of superior mesenteric artery syndrome", 171, pp.1279~1281 (1998)
- "Superior mesenteric artery syndrome", 37, pp.640~643 (2002)
- "Superior mesenteric artery syndrome", 11, pp.90~95 (2005)
- "Clinical study of 11 cases of the superior mesenteric artery syndrome", 21, pp.554~560 (1989)
- "Superior mesenteric artery syndrome in pediatric orthopedic patients", 250, pp.250~257 (1990)
- "Superior mesenteric artery syndrome", 93, pp.606~608 (2000)
- "Superior mesenteric artery syndrome", 59, pp.376~379 (1983)