Abstract
This is the first case report of the superior mesenteric artery syndrome developing in a patient following total proctocolectomy and ileal J-pouch anal anastomosis. In addition, this is the first demonstration of this syndrome using abdominal CT scan. A 22-year-old veteran underwent total proctocolectomy for left-sided ulcerative colitis because of failure of medical therapy. At operation an ileal J-pouch anal anastomosis was constructed. Following operation, the patient developed an intestinal obstruction. Abdominal CT scan demonstrated scant retroperitoneal fatty tissue, massive dilatation of the duodenum proximal to the midline, and tapered narrowing of the duodenum between the superior mesenteric artery and aorta. These findings indicated superior mesenteric artery syndrome: arteriomesenteric obstruction of the duodenum. Based on the experience of this case, the authors believe that compression of the duodenum by the superior mesenteric artery may be a common but unsuspected cause of prolonged postoperative ileus or early postoperative obstruction following ileal pouch anal anastomosis.
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References
von Rokitanski C. Lehrbuch der pathologischen Anatomie. Wein: W Braunmüller, 1842;3:187.
Berk RN, Coulson DB. The body cast syndrome. Radiology 1970;94:303–5.
Evarts CM, Winter RB, Hall JE. Vascular compression of the duodenum associated with the treatment of scoliosis: review of the literature and report of eighteen cases. J Bone Joint Surg [Am] 1971;53:431–44.
Hall LW. The cast syndrome incognito. Am J Surg 1973;127:371–6.
Nelson JP, Ferris DO, Ivins JC. The cast syndrome: case report. Postgrad Med 1967;42:457–61.
Schwartz DR, Wirka HW. The cast syndrome: a case report and discussion of the literature. J Bone Joint Surg [Am] 1964;46: 1549–52.
Wayne E, Miller RE, Eiseman B Duodenal obstruction by the superior mesenteric artery in bedridden combat casualties. Ann Surg 1971;174:339–45.
Ogbuokiri CG, Law EJ, MacMillan BG. Superior mesenteric artery syndrome in burned children. Am J Surg 1972;124:75–9.
Reckler JM, Bruck HM, Munster AM, Curreri PW, Pruitt BA Jr. Superior mesenteric artery syndrome as a consequence of burn injury. J Trauma 1972;12:979–85.
Wallace RG, Howard WB. Acute superior mesenteric artery syndrome in the severely burned patient. Radiology 1970;94:307–10.
Taylor BM, Beart RW Jr Dozois RR, Kelly KA, Wolff BG, Ilstrup DM. The endorectal ileal pouch-anal anastomosis: current clinical results. Dis Colon Rectum 1984;27:347–50.
Muller R Quoted by Barner HB, Sherman CD Jr. Vascular compression of the duodenum. Int Abstr Surg 1963;117:103–18.
Martin LW, LeCoultre C, Schubert WK. Total colectomy and mucosal proctectomy with preservation of continence in ulcerative colitis. Ann Surg 1977;186:477–80.
Martin LW, Fischer JE. Preservation of anorectal continence following total colectomy. Ann Surg 1982;196:700–4.
Strong EK. Mechanics of arteriomesenteric duodenal obstruction and direct surgical attack upon etiology. Ann Surg 1958;148: 725–30.
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Ballantyne, G.H., Graham, S.M., Hammers, L. et al. Superior mesenteric artery syndrome following ileal J-pouch anal anastomosis. Dis Colon Rectum 30, 472–474 (1987). https://doi.org/10.1007/BF02556500
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DOI: https://doi.org/10.1007/BF02556500