肠系膜上动脉综合征SMA.ppt

Superior mesenteric artery syndrome superior mesenteric artery syndrome is a very rare, life-threatening gastrovascular disorder characterized by a compression of the third portion of the duodenum by the superior mesenteric artery. SMA syndrome was first described in 1861 by Carl Freiherr von Rokitansky in victims at autopsy, but remained pathologically undefined until 1927 when Wilkie published the first comprehensive series of 75 patients.With only about 500 reported cases in the history of English-language medical literature,SMA syndrome is estimated to have a mortality rate of 1 in 3. SMA syndrome is also known as Wilkies syndrome, cast syndrome, mesenteric root syndrome, chronic duodenal ileus It is distinct from Nutcracker syndrome,which is the entrapment of the left renal vein between the AA and the SMA. causes The syndrome is typically caused by an angle of 6-25°between the AA and the SMA, in comparison to the normal range of 38-56°due to a lack of retroperitoneal and visceral fat. In addition, the aorto-mesenteric distance is 2-8 millimeters, as opposed to the typical 10-20. Retroperitoneal fat and lymphatic tissue normally serve as a cushion for the duodenum, protecting it from compression by the SMA. SMA syndrome is thus triggered by any condition involving an insubstantial cushion and narrow mesenteric angle.SMA Syndrome can present in two forms: chronic/congenital or acute/induced . Risk anatomic factors such as: very thin or lanky body build, an unusually high insertion of the duodenum at the ligament of Treitz, a particularly low origin of the SMA. Predisposition easily aggravated such as poor motility of the digestive tract retroperitional tumors cachexia exaggerated lumbar lordosis visceroptosis abdominal wall laxity peritoneal adhesions abdominal trauma rapid linear adolescent growth spurt, weight loss starvation catabolic states(cancer and burns). Symptoms