Superior mesenteric artery syndrome as a cause of acute pancreatitis.
Superior mesenteric artery syndrome as a cause of acute pancreatitis.
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DOI：
10.1136/bcr-2016-217073
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发表时间：
2016-09-19
期刊：
影响因子：
0.9
通讯作者：
Imai, Hiroshi
中科院分区：
文献类型：
--
作者：
Kojima, Shinichi;Suzuki, Kei;Imai, Hiroshi
一名76岁男子，无酗酒史，因反复呕吐后意识障碍被送往急诊室。到达时，他昏昏欲睡，处于休克状态，收缩压为1.60 mm Hg，心率为150 bpm。体格检查时，患者出现恶病质（体重指数，15.6 kg/m2）伴腹胀。CT平片显示胃和十二指肠扩张，十二指肠第三部分突然变窄，上级肠系膜动脉（SMA）在过渡点前交叉（图1A）。实验室检查显示血清淀粉酶升高4132 U/L，C反应蛋白升高10.74 mg/dL，肝酶中度升高。经鼻胃管胃减压后进行的对比CT显示胰头肿胀和周围积液（图1 B）。超声检查未显示胆系结石。重建CT显示肠系膜与肠系膜夹角减小至18（图2）。虽然不能否认特发性病例，但患者被诊断为急性胰腺炎伴低血容量性休克，这是由于SMA综合征（SMAS）和气胀引起的十二指肠内压升高所致。1例患者因急性胰腺炎接受保守治疗，并因SMAS接受鼻胃引流，24小时内从休克中恢复。肠内营养使他的营养状况逐渐改善，6周后他被转移到另一家医院接受后续治疗，没有复发急性胰腺炎。
A 76-year-old man with no history of alcohol abuse was brought to the emergency department with disturbance of consciousness after repeated vomiting. On arrival, he was drowsy and in shock with a systolic blood pressure of∼ 60 mm Hg and heart rate of 150 bpm. On physical examination, he was cachectic (body mass index, 15.6 kg/m2) with a distended abdomen. Plain CT showed gastric and duodenal distension with abrupt narrowing at the third portion of the duodenum, with the superior mesenteric artery (SMA) crossing anterior to the transition point (figure 1 A). Laboratory examination revealed elevated serum amylase of 4132 U/L and C reactive protein of 10.74 mg/dL, with moderately elevated liver enzymes. Contrast CT performed after gastric decompression via nasogastric tube demonstrated swelling of the pancreatic head and surrounding fluid collection (figure 1 B). Ultrasonography did not show biliary stone. Reconstructed CT revealed a reduced aortomesenteric angle of 18 (figure 2). Although idiopathic case could not be denied, the patient was diagnosed with acute pancreatitis with hypovolemic shock resulting from increased intraduodenal pressure due to SMA syndrome (SMAS) and gas bloat. 1 He was treated conservatively for acute pancreatitis with nasogastric drainage for SMAS, and recovered from shock in 24 hours. Enteral alimentation resulted in gradual improvement of his nutritional status, and he was transferred to another hospital for subsequent management after 6 weeks, without recurrence of acute pancreatitis.