左半結腸切除術後に発症した上腸間膜動脈症候群の1例

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  • SUPERIOR MESENTERIC ARTERY (SMA) SYNDROME AFTER LEFT HEMICOLECTOMY-A CASE REPORT-

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A 74-year-old man came to our hospital complaining of constipation. He was diagnosed with descending colon cancer and underwent a left hemicolectomy. He started taking meals on the 9th day after operation, but had repeated vomiting one or two hours after meals. Abdominal computed tomography revealed that the third portion of duodenum was compressed between the SMA and abdominal aorta, and that the stomach and duodenum were dilated. Gastroduodenography showed a straight line cut-off of the third portion of the duodenum, and stomach and duodenum dilatation after that. He was diagnosed as having SMA syndrome after left hemicolectomy. Conservative therapy for about two weeks was not effective, and he underwent surgical reoperation. The root of the mesenterium including the SMA had occluded the third portion of the duodenum, and a gastrojejunostomy was performed. The change of anatomical characteristics between the SMA and duodenum is considered one of the causes of SMA syndrome. In this case, the root of mesenterium was thought to be retracted inferiorily by the colonic anastomosis. The postoperative course was uneventful. Anterior transposition of the duodenum, duodenojejunostomy, and Treitz's ligament resection are known as other surgical procedures for treatment of this disease.

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