The Research Of Diagnosis And Treatment For133Cases Of Superior Mesenteric Artery Syndrome

Background and ObjectiveSuperior mesenteric artery syndrome (SMAS), was earliest mentioned by Rokitansky in1861. The syndrome due to the obstruction in the third part of the duodenum was compressed by the angle which constituted by the superior mesenteric artery or it’s branch and the abdominal aortic.It also known as the duodenum Arteriomesenteric syndrome, Wilkie’s syndrome, cast syndrome, and so on.Because the duodenum was compressed, the patients of SMAS have the symptoms like abdominal distension and pain, queasiness, vomiting repeatedly and abnormal bowel sounds.Although it’s a long time since we found it,because the lack acknowledge of SMAS in physicians(specifically in our country),and the lack of unique symptoms of SMAS,there still always be the misdiagnosed to this disease.This article summary the experience in diagnosis and treatment of superior mesenteric artery syndrome in our hospital.MethodsThe clinical data of133patients’ admitte between2003.09-2012.09in our hospital were retrospectively analyzed.Specifically in Diagnostic methods, misdiagnose reason, and contrast the effect of treatment program and the experience of surgical choice in surgical treatment.ResultsIn diagnostic aspects:result In133patiens:105patients were first subjected to barium meal examination,86patients had identified diagnosis;18patients were first subjected to CT examination,12patients had identified diagnosis;7patients had identified diagnosis just by abdominal Doppler ultrasound;3patients had identified diagnosis just by arteriography examination.And then the undiagnosed patients in the first round of checks, combination with other such checks were also to confirm the diagnosis.In misdiagnose aspects:Before the patients had identified SMAS, already misdiagnosed as chronic superficial gastritis in13cases; as functional dyspepsia in5cases; as gastric ulcer in12cases; as duodenal ulcer in3cases; as chronic cholecystitis and cholelithiasis in1case; as depressive disorder in1case.In treatment aspects:In all133cases,2cases accepted operative treatment at first who fails after repeated conservative treatment before;131cases accepted conservative treatment at first,and23cases failure then accepted operative treatment.In total25cases of operation:16cases chose open surgery and9cases chose laparoscopic surgery. The surgical procedures for these patients included lysis of the Treitz ligament in3cases, duodenojejunostomy in17cases (laparoscopic surgery in7cases), lysis of the Treitz ligament and duodenojejunostomy in1case, gastrojejunostomy and duodenojejunostomy in3cases (laparoscopic surgery in2cases), the superior mesenteric artery stretch in1case.All patients after operation were cured and followed up.ConclusionsGastrointestinal contrast, Doppler ultrasound, Computer tomography and arteriography examination are the reliably diagnostic methods for SMAS. The reason of misdiagnose mainly because physicians lack of awareness of the disease that lead to lack the acknowledge of relevant evidence in relevant examination.Most of the SMAS patients can alleviate by conservative treatment. Surgery should be performed after conservative treatment failure. Laparoscopic surgery to this treatment is feasible.