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Lao BB, Pitts AM, Thomas A, Camacho SM. Superior Mesenteric Artery Syndrome and Nutcracker Syndrome as the Presentation of Crohn's Disease in a Young Patient: A Case Report and Review of Literature. JPGN REPORTS 2023; 4:e357. [PMID: 38034441 PMCID: PMC10684153 DOI: 10.1097/pg9.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/27/2023] [Indexed: 12/02/2023]
Abstract
Superior mesenteric artery syndrome and nutcracker syndrome are rare vascular complications most often seen after marked weight loss caused by compression of the duodenum and left renal vein between the superior mesenteric artery and the aorta, respectively. The coexistence of superior mesenteric artery syndrome and nutcracker syndrome has been rarely reported. Herein, we present the case of a 16-year-old male with intermittent periumbilical abdominal pain, bilious vomiting, and weight loss who was found to have both of these vascular complications of significant weight loss as the initial presentation of Crohn's disease. This report provides insight into the diagnosis and treatment of these syndromes while highlighting the importance for practitioners to keep vascular complications on their differential diagnosis of vomiting and abdominal pain in patients with Crohn's disease.
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Affiliation(s)
- Breanna Belle Lao
- From the Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS
| | | | - Aby Thomas
- Division of Pediatric Imaging, Department of Radiology, University of Mississippi Medical Center, Jackson, MS
| | - Sandra M. Camacho
- Division of Gastroenterology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS
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2
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Itagaki H, Abe Y, Endo T. Massive Gastric Dilatation and Multi-Organ Ischemia Due to Superior Mesenteric Artery Syndrome: A Rare Case Report. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e940910. [PMID: 37705230 PMCID: PMC10507955 DOI: 10.12659/ajcr.940910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/02/2023] [Accepted: 07/18/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Superior mesenteric artery (SMA) syndrome, a rare condition in which the SMA and aorta occlude the third duodenal portion, can cause serious complications. We present the case of an 83-year-old Japanese man who presented with shock because of massive gastric dilatation due to SMA syndrome and developed multi-organ ischemia. CASE REPORT The day before admission, the patient had visited the emergency department with abdominal pain and was sent home following spontaneous symptom resolution, but experienced abdominal pain flare-up. His history included diabetes mellitus, hypertension, gastric ulcer, prostatic hypertrophy, esophageal hiatal hernia, and esophageal cancer. Plain computed tomography showed gastric dilatation and obstruction of the duodenal third portion by the SMA, leading to SMA syndrome diagnosis. Since a nasogastric tube could not be manually inserted into the stomach and the gastric dilatation could not be decompressed, the tube was inserted endoscopically. Endoscopy revealed mechanical obstruction of the gastric cardia and gastric mucosal ischemia. He was admitted to intensive care, and blood pressure was maintained with vasopressors and blood transfusion. The next day, contrast-enhanced computed tomography performed for persistently elevated lactate levels revealed extensive ischemia affecting multiple gastrointestinal organs. Surgery and other treatments were considered too risky due to the patient's advanced age and condition. Best supportive care was administered after discussion with the family, and he died on the second day of hospitalization. CONCLUSIONS SMA syndrome with extensive ischemia and infarction is rare. Given this, clinicians should remain vigilant for its potential complications.
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Deng Y, Yang H, Nie L, Yue Q, Zhang B, Wu B. Isotropic dynamic contrast-enhanced magnetic resonance imaging using differential subsampling with cartesian ordering and adaptive imaging receive coil for the diagnosis of Crohn disease: a case description. Quant Imaging Med Surg 2023; 13:5379-5384. [PMID: 37581066 PMCID: PMC10423386 DOI: 10.21037/qims-22-1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 05/11/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Yujiao Deng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Lisha Nie
- GE Healthcare, MR Research China, Beijing, China
| | - Qiang Yue
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- GE Healthcare, MR Research China, Beijing, China
| | - Bing Wu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Oka A, Awoniyi M, Hasegawa N, Yoshida Y, Tobita H, Ishimura N, Ishihara S. Superior mesenteric artery syndrome: Diagnosis and management. World J Clin Cases 2023; 11:3369-3384. [PMID: 37383896 PMCID: PMC10294176 DOI: 10.12998/wjcc.v11.i15.3369] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/13/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
Superior mesenteric artery (SMA) syndrome (also known as Wilkie's syndrome, cast syndrome, or aorto-mesenteric compass syndrome) is an obstruction of the duodenum caused by extrinsic compression between the SMA and the aorta. The median age of patients is 23 years old (range 0-91 years old) and predominant in females over males with a ratio of 3:2. The symptoms are variable, consisting of postprandial abdominal pain, nausea and vomiting, early satiety, anorexia, and weight loss and can mimic anorexia nervosa or functional dyspepsia. Because recurrent vomiting leads to aspiration pneumonia or respiratory depression via metabolic alkalosis, early diagnosis is required. The useful diagnostic modalities are computed tomography as a standard tool and ultrasonography, which has advantages in safety and capability of real-time assessments of SMA mobility and duodenum passage. The initial treatment is usually conservative, including postural change, gastroduodenal decompression, and nutrient management (success rates: 70%-80%). If conservative therapy fails, surgical treatment (i.e., laparoscopic duodenojejunostomy) is recommended (success rates: 80%-100%).
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Affiliation(s)
- Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Muyiwa Awoniyi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Hepatology Section, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Nobuaki Hasegawa
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yuri Yoshida
- Clinical Laboratory Division, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Hiroshi Tobita
- Division of Hepatology, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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Cicero G, Ascenti G, Blandino A, Booz C, Vogl TJ, Trimarchi R, D'Angelo T, Mazziotti S. Overview of the Large Bowel Assessment Using Magnetic Resonance Imaging: Different Techniques for Current and Emerging Clinical Applications. Curr Med Imaging 2022; 18:1031-1045. [PMID: 35362386 DOI: 10.2174/1573405618666220331111237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/29/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022]
Abstract
Radiological assessments of the small and large bowel are essential in daily clinical practice. Over plain film X-ray and ultrasound, cross-sectional techniques are considered the most comprehensive imaging modalities. In fact, computed tomography and magnetic resonance imaging take great advantage of the three-dimensional appraisal and the extensive evaluation of the abdominal cavity, allowing intestinal evaluation as well as detection of extra-intestinal findings. In this context, the chief advantage of computed tomography is the fast scan time, which is crucial for emergency cases. Nonetheless, it is undeniably impaired using ionizing radiation. As the awareness of radiation exposure is a topic of increasing importance, magnetic resonance imaging is not only becoming a mere alternative but also a primary imaging technique used in assessing intestinal diseases. Specifically, the evaluation of the large bowel through MRI can be still considered relatively uncharted territory. Although it has demonstrated superior accuracy in the assessment of some clinical entities from inflammatory bowel disease to rectal carcinoma, its role needs to be consolidated in many other conditions. Moreover, different technical methods can be applied for colonic evaluation depending on the specific disease and segment involved. This article aims to provide a thorough overview of the techniques that can be utilized in the evaluation of the large bowel and a discussion on the major findings in different colonic pathologies of primary interest.
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Affiliation(s)
- Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Christian Booz
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Thomas J Vogl
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Renato Trimarchi
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
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Apostu RC, Chira L, Colcear D, Lebovici A, Nagy G, Scurtu RR, Drasovean R. Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature. World J Clin Cases 2022; 10:1654-1666. [PMID: 35211606 PMCID: PMC8855252 DOI: 10.12998/wjcc.v10.i5.1654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/05/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome is a disease with a complex diagnosis, and it is associated with complications that make it even harder to identify. Currently, a frequent association with psychiatric disorders has been noted. Despite numerous case reports and case series, the variability of the disease has not allowed the development of protocols regarding diagnosis and management.
CASE SUMMARY A 33-year-old woman presented with abdominal pain, nausea, and bile vomiting over the last 15 mo, associated with a 15-kg weight loss over the last three months. After the onset of the symptoms, the patient was diagnosed with anxiety-depressive disorder and treated appropriately. Standard examinations excluded an organic cause, and the cause of the symptoms was considered psychogenic. The persistence of symptoms, even under treatment, prompted a computer tomography angiography examination of the abdomen and pelvis. The examination identified emergence at a sharp angle of 13.7° of the superior mesenteric artery, with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm. A diagnosis of aortomesenteric clamp was established. Surgical treatment by laparoscopic duodenojejunostomy was performed. Postoperative evolution was marked by a patent anastomosis at 1 mo, with a 10-kg weight gain and improvement of the associated anxiety.
CONCLUSION This case report underlines two major aspects. One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders, with an excellent outcome when proper treatment is administered. The second aspect underlines the key role of a multidisciplinary approach and follow-up.
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Affiliation(s)
- Raluca Cristina Apostu
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400001, Romania
| | - Lucian Chira
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400001, Romania
| | - Doina Colcear
- Department of Psychiatry, Clinical Infectious Disease Hospital, Cluj-Napoca 400000, Romania
| | - Andrei Lebovici
- Department of Radiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
| | - Georgiana Nagy
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400006, Romania
| | - Radu Razvan Scurtu
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400001, Romania
| | - Radu Drasovean
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400001, Romania
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Cicero G, Blandino A, D'Angelo T, Booz C, Vogl TJ, Ascenti G, Mazziotti S. Mimicking conditions of intestinal Crohn's disease: magnetic resonance enterography findings. Jpn J Radiol 2021; 40:19-28. [PMID: 34304381 DOI: 10.1007/s11604-021-01177-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022]
Abstract
Crohn's disease is a chronic inflammatory condition characterized by a transmural involvement of intestinal walls. Its diagnosis comes from a combination of clinical data, imaging findings and, above all, endoscopy with biopsy results, which are mandatory for achieving a definitive diagnosis. Even so, endoscopy information may be unavailable, for instance due to technical impairments or patient intolerance. On the radiological side, Magnetic Resonance Enterography is currently considered the imaging technique of choice for Crohn's disease assessment, either at first diagnosis or follow-up. Nevertheless, the lack of radiation exposure as well as invasiveness has made this imaging approach suitable also for the evaluation of a number of small and large bowel diseases over recent years. However, it is important to remember that Magnetic Resonance Imaging findings are non-specific and that a wide overlap exists among Crohn's disease and other intestinal conditions. The aim of this work was to provide a series of intestinal affections evaluated through Magnetic Resonance Enterography that resemble Crohn's disease and that can be helpful in avoiding misinterpretation, especially when endoscopy data are missing.
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Affiliation(s)
- Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy
| | - Christian Booz
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Thomas J Vogl
- Division of Experimental and Translational Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy
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8
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Zhang TT, Chang W, Wang ZJ, Sun DC, Ohliger MA, Yeh BM. Bowel Wall Visualization Using MR Enterography in Relationship to Bowel Lumen Contents and Patient Demographics. J Magn Reson Imaging 2021; 54:728-736. [DOI: 10.1002/jmri.27589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Ting Ting Zhang
- Department of Radiology and Biomedical Imaging UCSF Medical Center San Francisco California USA
- Department of Radiology Xinhua Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Wei‐Chou Chang
- Department of Radiology and Biomedical Imaging UCSF Medical Center San Francisco California USA
- Department of Radiology Tri‐Service General Hospital, National Defense Medical Center Taipei Taiwan
| | - Zhen Jane Wang
- Department of Radiology and Biomedical Imaging UCSF Medical Center San Francisco California USA
| | - Derek C. Sun
- Department of Radiology and Biomedical Imaging UCSF Medical Center San Francisco California USA
| | - Michael A. Ohliger
- Department of Radiology and Biomedical Imaging UCSF Medical Center San Francisco California USA
| | - Benjamin M. Yeh
- Department of Radiology and Biomedical Imaging UCSF Medical Center San Francisco California USA
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Farina R, Foti PV, Conti A, Iannace FA, Pennisi I, Fanzone L, Inì C, Libra F, Vacirca F, Failla G, Baldanza D, Palmucci S, Santonocito S, Basile A. The role of ultrasound imaging in vascular compression syndromes. Ultrasound J 2021; 13:4. [PMID: 33555480 PMCID: PMC7870731 DOI: 10.1186/s13089-020-00202-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/14/2020] [Indexed: 11/24/2022] Open
Abstract
Vascular compression syndromes are rare alterations that have in common the compression of an arterial and/or venous vessel by contiguous structures and can be congenital or acquired. The best known are the Thoracic Outlet Syndrome, Nutcracker Syndrome, May–Thurner Syndrome, and Dunbar Syndrome. The incidence of these pathologies is certainly underestimated due to the non-specific clinical signs and their frequent asymptomaticity. Being a first-level method, Ultrasound plays a very important role in identifying these alterations, almost always allowing a complete diagnostic classification. If in expert hands, this method can significantly contribute to the reduction of false negatives, especially in the asymptomatic population, where the finding of the aforementioned pathologies often happens randomly following routine checks. In this review, we briefly discuss the best known vascular changes, the corresponding ultrasound anatomy, and typical ultrasound patterns.
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Affiliation(s)
- Renato Farina
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy.
| | - Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Andrea Conti
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Francesco Aldo Iannace
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Isabella Pennisi
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Luigi Fanzone
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Corrado Inì
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Federica Libra
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Francesco Vacirca
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Giovanni Failla
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Davide Baldanza
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Serafino Santonocito
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
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Cicero G, Mazziotti S. Crohn's disease at radiological imaging: focus on techniques and intestinal tract. Intest Res 2020; 19:365-378. [PMID: 33232590 PMCID: PMC8566824 DOI: 10.5217/ir.2020.00097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/02/2020] [Indexed: 11/05/2022] Open
Abstract
Over recent years, inflammatory bowel diseases have become an issue of increased attention in daily clinical practice, due to both a rising incidence and improved imaging capability in detection. In particular, the diagnosis of Crohn's disease is based on clinical picture, laboratory tests and colonoscopy with biopsy. However, colonoscopic evaluation is limited to the mucosal layer. Thus, imaging modalities play a pivotal role in enriching the clinical picture, delivering information on intestinal and extraintestinal involvement. All the imaging modalities can be employed in evaluation of Crohn's disease patients, each of them with specific strengths as well as limitations. In this wide selection, the choice of a proper diagnostic framework can be challenging for the clinician. Therefore, the aim of this work is to offer an overview of the different imaging techniques, with brief technical details and diagnostic potential related to each intestinal tract.
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Affiliation(s)
- Giuseppe Cicero
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Silvio Mazziotti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
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11
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Šalamon Janečić M, Grmoja T, Tripalo Batoš A, Hojsak I. Superior mesenteric artery syndrome complicating the clinical presentation and treatment of inflammatory bowel disease in a pediatric patient. Minerva Pediatr (Torino) 2020; 74:222-223. [PMID: 33107276 DOI: 10.23736/s2724-5276.20.05988-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Mia Šalamon Janečić
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| | - Tonći Grmoja
- Department of Pediatric Radiology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Ana Tripalo Batoš
- Department of Pediatric Radiology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia - .,School of Medicine, University of Zagreb, Zagreb, Croatia.,School of Medicine, University J.J. Strossmayer, Osijek, Croatia
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12
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Diab S, Hayek F. Combined Superior Mesenteric Artery Syndrome and Nutcracker Syndrome in a Young Patient: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922619. [PMID: 32772039 PMCID: PMC7440741 DOI: 10.12659/ajcr.922619] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patient: Male, 18-year-old Final Diagnosis: Superior mesenteric artery syndrome Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Samer Diab
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Fadi Hayek
- Department of Vascular and Endovascular Surgery, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
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13
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Cicero G, Mondello S, Wichmann JL, Albrecht MH, Vogl TJ, Cavallaro M, Frosina L, D'Angelo T, Mazziotti S. Fast Magnetic Resonance Enterography Protocol for the Evaluation of Patients with Crohn's Disease: A Pilot Study. J Clin Imaging Sci 2020; 10:25. [PMID: 32363087 PMCID: PMC7193210 DOI: 10.25259/jcis_18_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/16/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Magnetic resonance enterography has achieved an increasingly importance in the evaluation of patients with Crohn's disease, although it is limited by high costs and prolonged scanning times. The aim of our work was to design a "fast" abbreviated MRE protocol and to compare it with the standard one. Materials and Methods A single-center retrospective study was performed on 73 patients with Crohn's disease who underwent MRE with standard protocol over a 7-month period. The images of the standard protocol were separated from those included in the proposed abbreviated one and independently evaluated by two radiologists with different years of experience in MRE imaging. Statistical analysis was performed with the Cohen kappa (κ) value, used to assess the agreement in case of categorical variables, the Lin's concordance correlation coefficient and Bland-Altman plot, in assessing the degree of agreement between numerical measurements, while the non- parametric Mann-Whitney U-test was used in comparing the evaluation times of the two protocols. Results The intraobserver evaluation showed a perfect agreement between the two protocols for presence, number and extension of lesions, abdominal complications, and excellent/perfect in identification of active inflammation.The interobserver reproducibility was excellent for overall presence and number of lesions, for the presence and number of lesions in any abdominal quadrant, inflammation, intestinal and extraintestinal complications, and lesions extension. Conclusion The proposed protocol achieves comparable performance with standard MRE. Furthermore, it would carry potential benefits in terms of patient's comfort, time, and health-care costs savings.
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Affiliation(s)
- Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
| | - Stefania Mondello
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
| | - Julian L Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Marco Cavallaro
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
| | - Luciano Frosina
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
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Acute Kidney Injury Caused by Superior Mesenteric Artery Syndrome. Case Rep Nephrol 2020; 2020:8364176. [PMID: 32328326 PMCID: PMC7171609 DOI: 10.1155/2020/8364176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/04/2020] [Indexed: 12/30/2022] Open
Abstract
Background Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction leading to acute kidney injury (AKI). Methods We report a case of 23-year-old army personnel who presented with persistent vomiting leading to severe hypokalaemia, metabolic alkalosis, and acute kidney injury resulting in cardiorespiratory arrest. Results After successful resuscitation, he was supported with haemodialysis and aggressive electrolytes correction. He was repeatedly not able to tolerate nasogastric (NG) tube feeding and computerised tomography of abdomen was performed, and the diagnosis of SMA syndrome was made. Gastroscopy examination revealed duodenal ulcer at D1, pinhole D1-D2 junction, but there was no evidence of intraluminal mass or lesions leading to upper gastrointestinal obstruction. A nasojejunal tube was inserted to bypass the narrow segment of the duodenum, and he was put on nutritional support. He was subsequently weaned off dialysis support as his renal function gradually improved and later on normalised. He remains symptoms free, and he gained five kilograms in four months after discharge. Conclusions SMA syndrome is a rare cause of upper gastrointestinal obstruction but should be considered as a differential diagnosis in a patient who presented with recurrent vomiting and AKI with metabolic alkalosis.
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Farina R, Iannace FA, Foti PV, Conti A, Inì C, Libra F, Fanzone L, Coronella ME, Santonocito S, Basile A. A Case of Nutcracker Syndrome Combined with Wilkie Syndrome with Unusual Clinical Presentation. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922715. [PMID: 32317620 PMCID: PMC7193224 DOI: 10.12659/ajcr.922715] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nutcracker syndrome and Wilkie's syndrome are rare vascular diseases due to the abnormal course of the superior mesenteric artery originating from the abdominal aorta with reduced angle (<22°) and consequent compression of the left renal vein (nutcracker) and duodenum (Wilkie). Here, we report the case of a patient with a rare combination of these 2 syndromes and with unusual clinical manifestation of post-prandial pain. CASE REPORT We describe the case of a young male patient with rapid weight loss, coupled with post-prandial abdominal pain, with sub-acute onset, not associated with other symptoms. The ultrasound examination found an aorto-mesenteric angle of 18° and compression of the left renal vein and left varicocele. A CT study was performed to exclude oncological diseases and/or other pathologies responsible for the pain and weight loss, which confirmed the ultrasound findings and showed compression of the third part of the duodenum. The patient underwent endovascular treatment, with stent placement in the left renal vein, which resolved the vascular compression and of the duodenum, with regression of symptoms. CONCLUSIONS The ultrasound scan promptly highlighted the reduction of the aorto-mesenteric angle and the signs of venous congestion of the left renal vein. Based on this experience, in patients with weight loss and post-prandial pain, in our opinion, diagnostic investigations should also be extended to the study of the aorto-mesenteric angle to confirm or exclude any vascular and/or duodenal compression.
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Affiliation(s)
- Renato Farina
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Francesco Aldo Iannace
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Andrea Conti
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Corrado Inì
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Federica Libra
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Luigi Fanzone
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Maria Enza Coronella
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Serafino Santonocito
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
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Superior Mesenteric Artery Syndrome as a Presenting Sign of Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2020; 70:e51-e52. [PMID: 31978036 DOI: 10.1097/mpg.0000000000002558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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17
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Abstract
PURPOSE To provide a review of the etiology, clinical presentation, and imaging findings of superior mesenteric artery (SMA) syndrome. METHODS A literature review of 24 relevant articles regarding SMA syndrome was performed. RESULTS Clinicians and radiologists with a high index of suspicion based on symptomatology may pursue radiologic investigation in the form of upper gastrointestinal (GI) series and contrast-enhanced abdominal computed tomography (CT). Magnetic resonance imaging (MRI) and ultrasound (US) are less commonly utilized modalities in the work-up of SMA syndrome, but provide imaging alternatives without the use of ionizing radiation. Imaging can assist in diagnosis by demonstrating characteristic findings of reduced aortomesenteric angle, reduced aortomesenteric distance, gastroduodenal distention, bowel caliber narrowing at the takeoff of the superior mesenteric artery from the aorta, as well as delayed gastric emptying or positional obstruction observed with real time with fluoroscopy. CONCLUSION SMA syndrome is a rare disease that can go unrecognized and undiagnosed, exacerbating weight loss in an already significantly malnourished patient population. The diagnosis of SMA syndrome must be based on clinical symptomatology correlated with radiographic information. Once diagnosed, SMA syndrome can be safely treated by conservative measures although occasionally requires invasive intervention in the form of enteral tube placement, percutaneous jejunostomy tube placement, total parenteral nutrition, ligament of Treitz lysis, or duodenojejunostomy.
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Shi Y, Shi G, Li Z, Chen Y, Tang S, Huang W. Superior mesenteric artery syndrome coexists with Nutcracker syndrome in a female: a case report. BMC Gastroenterol 2019; 19:15. [PMID: 30674275 PMCID: PMC6343343 DOI: 10.1186/s12876-019-0932-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 01/14/2019] [Indexed: 12/25/2022] Open
Abstract
Background Superior mesenteric artery (SMA) syndrome, also known as Wilkie’s syndrome or Benign duodenal stasis, is a rare benign disease. It could threaten the life if the manifestation is severe and the treatment is inappropriate. In the patients with SMA syndrome, the third portion (transverse part) of the duodenum is compressed externally between the SMA and abdominal aorta (AA) leading to duodenal stasis and gastrointestinal obstruction. SMA syndrome may rarely combine with Nutcracker syndrome when left renal vein (LRV) was compressed between SMA and AA. Case presentation A 32-year-old female patient presented with complaints of gradually severe bloating, epigastric pain, left flank ache, nausea and occasional vomiting of 1 month’s duration. The epigastric and left flank ache was aggravated when the patient was supine and relieved in a prone or left lateral decubitus. The abdominal bloating was associated with early satiety. The vomiting always started 40 min after meal. The patient gave a history of urine stone with drotaverine hydrochloride tablets treatment for two weeks before the gastrointestinal symptoms arising. The patient had no significant surgical history, but had a rapid weight loss of approximately 10 kg with a body mass index (BMI) from 21 kg/m2 to less than 18 kg/m2 over the last two months. An abdominal examination revealed upper abdominal tenderness and distention. The urine routine examination showed no significant abnormality. The findings of initial blood tests and other laboratory investigations were unremarkable. Conclusions This case reports a female patient with SMA syndrome with Nutcracker syndrome predisposed by Antispasmodics. We highlight the importance of the combination therapy of long-term nutritional supporting and prokinetic agents. Rehabilitating practice after discharge is beneficial to reduce recurrence.
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Affiliation(s)
- Ying Shi
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China. .,The First Clinical Medical College, Jinan University, Guangzhou, 510630, People's Republic of China.
| | - Guangya Shi
- Department of Gastroenterology, The People's Hospital of Fujian Province, 350004, Fujian, People's Republic of China
| | - Zhenyu Li
- Department of Radiology, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China
| | - Yanfang Chen
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China.,The First Clinical Medical College, Jinan University, Guangzhou, 510630, People's Republic of China
| | - Shaohui Tang
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China.,The First Clinical Medical College, Jinan University, Guangzhou, 510630, People's Republic of China
| | - Wei Huang
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China. .,The First Clinical Medical College, Jinan University, Guangzhou, 510630, People's Republic of China.
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