It may also occur spontaneously. The condition is important as the risk of rupture is high and carries a significant mortality rate . Superior mesenteric artery syndrome is more widely recognised, and results from obstruction of the duodenum where it passes between the superior mesenteric artery and aorta, by any process which narrows the angle between these two structures . In its commonest form it is not associated with an acquired AZD1480 ic50 structural abnormality:
the angle between the SMA and aorta is constitutionally narrowed. In its best-known acquired variant, the aortoduodenal syndrome, the duodenum is compressed between the SMA and an abdominal aortic aneurysm . This case is unique, comprising both the first description of a variant of SMA syndrome caused by a traumatic SMA pseudoaneurysm and the first account of successful treatment of both the aneurysm and duodenal obstruction by
endovascular stent placement. Case Report Our 40 year-old male patient was the driver of a vehicle that collided www.selleckchem.com/products/dibutyryl-camp-bucladesine.html at high speed with a fence post. He was transferred via air ambulance to hospital and on arrival was conscious and alert. Marked anterior abdominal wall bruising was evident consistent with injury relating to use of a lap belt, and he complained of diffuse abdominal pain. Abdominal computerised tomography (CT) demonstrated free Obeticholic concentration intraperitoneal fluid. At laparotomy, approximately 3000 mls of haemoperitoneum was evacuated and devascularising mesenteric injuries
were noted affecting segments of jejunum, terminal ileum, caecum and sigmoid colon (American Association for the Surgery of Trauma Grade 4 injuries). A subtotal colectomy with ileo-sigmoid anastamosis and resection of 10 cm of mid-jejunum was performed. Postoperative recovery was prolonged due to persistent vomiting, initially thought to be secondary to ileus. CT performed on postoperative Day 12 showed small bowel dilatation consistent with ileus and the small bowel anastomosis appeared unremarkable. This also demonstrated a small aneurysm at the SMA origin, which was only appreciated in retrospect (Figure 1). The presence of oral contrast opacifying most of the small bowel made interpretation more difficult. Two weeks later a barium small Urease bowel meal was performed due to persistent nausea and vomiting. This examination demonstrated dilatation of the proximal duodenum, with hold up of barium to the level of the fourth part, where a rounded filling defect causing extrinsic compression was noted (Figure 2). The patient subsequently became acutely unwell with a fever of 39.3°C, leucocytosis and tachycardia. A differential diagnosis of central venous catheter-related sepsis or intra-abdominal collection was considered and another abdominal CT was performed (two days after the small bowel meal). This demonstrated a 6.3 cm pseudoaneurysm in the central abdomen intimately related to the superior mesenteric artery (Figures 3 and 4).