上腸間膜動脈性十二指腸閉塞
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- 1. 上腸間膜動脈症候群superior mesenteric artery syndrome [show details]
… arteriomesenteric duodenal obstruction, and chronic duodenal ileus . The syndrome is characterized by compression of the third portion of the duodenum due to narrowing of the space between the superior mesenteric artery …
- 2. 慢性膵炎の合併症の概要overview of the complications of chronic pancreatitis [show details]
… Duodenal obstruction is characterized by postprandial pain and early satiety.… patient with chronic pancreatitis. A pseudoaneurysm appears as a cystic structure in the pancreas. Mesenteric angiography permits confirmation of the diagnosis, and also provides a means of therapy by embolization …
- 3. 消化性潰瘍の稀な原因unusual causes of peptic ulcer disease [show details]
… although annular pancreas can present at birth with high-grade duodenal obstruction,… vascular insufficiency syndromes involving arterial supply do rarely present with peptic ulceration that is unrelated to H.… while others may have symptoms suggestive of mesenteric angina with pain following meals.…
- 4. 胆嚢癌：疫学、危険因子、臨床的特徴、および診断gallbladder cancer epidemiology risk factors clinical features and diagnosis [show details]
… duct. Nodes that are beyond the hepatoduodenal ligament (including periaortic, pericaval, superior mesenteric artery, and celiac artery lymph nodes) are extraregional and staged as distant metastases (M1 … Invasion of tumor into the porta hepatis may also result in duodenal obstruction . The presence of duodenal obstruction implies unresectability.… dynamic cross-sectional imaging (CT or MRI) should include arterial phase images to determine the anatomic course of the hepatic arteries relative to the tumor,…
- 5. 内視鏡的逆行性胆道膵管造影（ERCP）ではあまり見られない合併症uncommon complications of endoscopic retrograde cholangiopancreatography ercp [show details]
… from a traumatic inadvertent cannulation of the superior mesenteric vein,… An arterial air embolism occurs when air in the venous system enters the arterial system through a patent foramen ovale… glucocorticoids . Development of a pseudotumor of the pancreatic head after therapeutic ERCP . Duodenal obstruction following papillary stenosis . Electrical burn in the liver secondary to sphincterotomy .…
English Journal
- Acute abdominal pain in an older patient.
- Keighley J, Howlett D.
- BMJ (Clinical research ed.). 2019 May;365()l1337.
- PMID 31043375
- Superior Mesenteric Artery Syndrome in a 6-Year-Old Girl with Final Diagnosis of Celiac Disease.
- Salehzadeh F, Samadi A, Mirzarahimi M.
- Case reports in gastrointestinal medicine. 2019 ;2019()3458601.
- Superior mesenteric artery syndrome (SMAS) occurs when the duodenum is compressed between the two arteries, superior mesenteric artery and aorta. The complications of this rarely found disorder in children range from causing trouble in duodenal functions to intestinal obstruction which is potentiall
- PMID 31089433
- Abdominal Pain Presenting as a Tight Squeeze on a Tchaikovsky Score.
- Ruffle JK, Power N, Aziz Q.
- Gastroenterology. 2019 02;156(3)e3-e5.
- PMID 30240663
Japanese Journal
- 正中弓状靱帯圧迫症候群による後上膵十二指腸動脈瘤破裂後十二指腸狭窄の１例
- 安田 剛士,片山 政伸,江口 大樹,竹田 善哉,伏木 邦博,小野澤 由里子,田中 基夫,重松 忠
- 日本消化器内視鏡学会雑誌 60(3), 230-236, 2018
- <p>症例は46歳男性．就寝中に突然腹痛が生じ，当院へ救急搬入された．来院後に出血性ショックに陥り，造影CTから正中弓状靱帯圧迫症候群（以下MALS）およびそれに合併した後上膵十二指腸動脈瘤破裂と診断した．緊急でTAEを行い止血を得たが，後日遅発性十二指腸狭窄が生じた．胃空腸吻合術なども考慮されたが，経腸栄養とTPNを併用して保存的に経過を追い，第45病日に退院した．一般的に膵十二指腸 …
- NAID 130006516148
Related Links
- Superior mesenteric artery syndrome was first described in 1861 by Von Rokitansky, who proposed that its cause was obstruction of the third part of the duodenum as a result of arteriomesenteric compression. Some studies [] ...
- Superior Mesenteric Artery Syndrome: A Rare Cause of Intestinal Obstruction. Diagnosis and Surgical Management Savas Yakan, Cemil Calıskan, Hasan Kaplan, Ali Galip Deneclı, and Ahmet Coker. Author information ...
- Superior mesenteric artery (SMA) syndrome, also known as Wilkie syndrome, is a rare acquired vascular compression disorder in which acute angulation of the superior mesenteric artery (SMA) results in compression of the third part ...
★リンクテーブル★
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- 英
- superior mesenteric artery syndrome
- 同
- SMA症候群、腸間膜動脈性十二指腸閉塞症候群 arteriomesenteric duodenum occulsion syndrome、胃腸間膜性イレウス症候群 gastromesenteric ileus syndrome、上腸間膜動脈性十二指腸閉塞 superior mesenteric arterial duodenal obstruction
- 関
- 上腸間膜動脈性十二指腸閉塞症
概念
- 上腸間膜動脈は腹部大動脈より前下方向に30°程度の角度をなして分岐する。
- 十二指腸の水平脚/水平部は腹部大動脈と上腸間膜動脈と挟まれるように存在する。
- 解剖学的な理由により、ある条件の下で十二指腸が動脈に挟まれて圧迫され通過障害を来し臨床症状を呈するのが本疾患である。
症状
増悪因子
- 背臥位：体位変換なく長期臥床を強いられている場合に起こりやすい。
軽快因子
- 腹臥位、左側臥位：腹部大動脈と上腸間膜動脈の間が開く形になるため。
リスク
- やせている人(特に女児)：腹部大動脈と上腸間膜動脈の間の脂肪が少ないため、腹部大動脈と上腸間膜動脈がより鋭角となり、十二指腸が圧迫されやすくなる。
診断
- 消化管造影で造影剤が十二指腸水平部で停滞し、かつ水平部の左右で腸管径に差があること。
- 腹部超音波検査で上腸間膜動脈と腹部大動脈のなす角が鋭角であること。(通常は30-42°程度)
十二指腸造影でほぼ正中に線状の圧迫がみられれば疑われ、血管撮影でそれが上腸間膜動脈であることが確認されれば確定される。
治療
- 軽症例：食後腹臥位または左側臥位をとらせる。
- 重症例：手術療法(十二指腸空腸吻合術、十二指腸遊離術)
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- 英
- superior mesenteric arterial duodenal obstruction
- 関
- 上腸間膜動脈症候群
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- 関
- dominance、dominant、dominantly、epi、epistasis、epistatic、excellent、good、predominately、senior、superio、superiorly、supra
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- 妨害、障害、支障、差し障り。妨害物、
- 閉塞、閉塞症。
- 関
- blockage、deterrent、obliteration、occlude、occlusion、stasis
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- 関
- epi、epistasis、epistatic、senior、superior、supra
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- 関
- arteriosus、artery
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先天性十二指腸閉鎖症、十二指腸閉鎖症