tailieunhanh - Báo cáo y học: "A causal relationship between right paraduodenal hernia and superior mesenteric artery syndrome: a case report."

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: A causal relationship between right paraduodenal hernia and superior mesenteric artery syndrome: a case report. | Fukada et al. Journal of Medical Case Reports 2010 4 159 http content 4 1 159 jA CASE REPORTS CASE REPORT Open Access A causal relationship between right paraduodenal hernia and superior mesenteric artery syndrome a case report Tadaomi Fukada 1 2 Hideyasu Mukai1 Fumihiko Shimamura1 Takeshi Furukawa1 2 and Masaru Miyazaki2 Abstract Introduction Cases of right paraduodenal hernia and superior mesenteric artery syndrome have been reported separately but their occurrence in combination has not been reported. Case presentation A 46-year-old Japanese man who had never undergone laparotomy was admitted to our hospital due to an acute abdomen. An enhanced multidetector-row computed tomography scan of our patient showed a cluster of small intestines with ischemic change in his right lateral abdominal cavity. Emergency surgery was subsequently performed and strangulation of the distal jejunum along with incidental right paraduodenal hernia was found. His necrotic ileum was resected and the jejunum encapsulated by the sac was repaired manually without reduction. Three days after the operation however our patient developed vomiting. An upper gastrointestinal series revealed a straight line cut-off sign on the third portion of his duodenum. A second enhanced multidetector-row computed tomography scan showed that he had a lower aortomesenteric angle and a shorter aortomesenteric distance compared to his condition before his right paraduodenal hernia was surgically repaired. We strongly suspected that the right paraduodenal hernia repair may have induced superior mesenteric artery syndrome. On the 21st postoperative day duodenojejunostomy was performed because conservative management had failed. Conclusions In this case enhanced multidetector-row computed tomography which permits reconstructed multiplanar imaging helped us to visually identify these diseases easily. It is important to recognize that surgical repair of a right .