Superior mesenteric artery syndrome

Abstract

Introduction. Extrinsic duodenal obstructive disease of the third part of the duodenum by compression between the aorta and the upper mesenteric artery. The aorto-mesenteric angle being less than 18 degrees. Aim of study. Diagnosis and surgical treatment of patients with chronic duodenal obstruction, by the aortomesenteric forceps mechanism. Methods and materials. 7 patients, aged between 21 and 46 years old and treated in the Surgery Department of St. Michael the Archangel Municipal Clinical Hospital, from 2012 to 2018. Results. Long medical history, with unsystematic epigastric pain, postprandial fullness, constipation. Underweight, with a BMI of 21.43kg / m2. Gastroduodenal radiography: relatively larger stomach, dilated duodenum with stasis of barium substance, pendular movements, duodenogastric reflux (DGR), delayed gastric and duodenal emptying. At angiographic CT, the aorto-mesenteric angle equal to 13.47 mm is determined. The surgical treatment undertaken: 1. Duodenojejunostomy L-L in 5 cases; 2. Strong Surgery in 2 cases. Simple postoperative evolution. Remote results: in 4 cases satisfactory results were recorded; in 2 cases constipation persisted, and in one case there were no changes. Conclusion. The aorto-mesenteric forceps syndrome is clinically suspected, confirmed by duodenography and CT with angiography. The surgical treatment consists in performing a bypass anastomosis or lowering the duodenojejunal angle, with acceptable results.