Multidisciplinary approach to a complex duodenal obstruction: From duodenal atresia to superior mesenteric artery syndrome

Surgery Case Reports Pub Date : 2024-05-29 DOI:10.1016/j.sycrs.2024.100028

Bigyan B. Mainali , Craig Follette , Thomas Pranikoff , Andrew M. Nunn

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Abstract

We present a 21yo female with a nausea, vomiting, and weight loss. Her history was remarkable for duodenal atresia repair as an infant. Following extensive evaluation, she was found to have progressive dilation of the proximal duodenum and loss of motility without obstruction (megaduodenum) which eventually lead to substantial weight loss resulting in superior mesenteric artery (SMA) syndrome. Given her symptomatic presentation, she was offered surgery and underwent a lateral duodenal tapering procedure and division of the ligament of Treitz and duodenal derotation (Strong procedure). Through the collaborative efforts of gastroenterology, pediatric surgery, radiology, and acute care surgery, she now has excellent functional status, has gained weight, and is asymptomatic. This case serves as an important example that congenital anomalies are a lifelong consideration when caring for patients

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多学科方法治疗复杂的十二指肠梗阻：从十二指肠闭锁到肠系膜上动脉综合征

我们接诊了一名 21 岁的女性，她有恶心、呕吐和体重减轻的症状。她曾在婴儿时期接受过十二指肠闭锁修复术。在对她进行了广泛的评估后，发现她的十二指肠近端逐渐扩张，失去运动能力，但没有梗阻（巨十二指肠），最终导致体重大幅下降，引发肠系膜上动脉（SMA）综合征。鉴于她的症状表现，医生建议她接受手术治疗，并为她实施了十二指肠外侧缩窄术、特雷兹韧带分离术和十二指肠外翻术（Strong 手术）。在消化内科、小儿外科、放射科和急诊外科的共同努力下，她现在的功能状况良好，体重增加了，而且没有任何症状。这个病例是一个重要的例子，说明先天性畸形是护理病人时需要终生考虑的问题。

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Surgery Case Reports

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