Small bowel obstruction by superior mesenteric artery syndrome: A diagnosis to know after intensive care stay, Occlusion par syndrome de la pince aorto-mesenterique: un diagnostic a connaitre en post-reanimation. [French, English]

Abstract

Introduction:-The superior mesenteric artery syndrome (SMAS) is a small bowel obstruction corresponding to a compression of the third portion of the duodenum (D3) between the mesenteric artery and the aorta. It was described for the first time by Rokitansky in 1861. This compression is due to the desperation of the adipose tissue between the aorta and the mesenteric artery. It is observed in the states of thinness or severe undernutrition. The clinical signs are a small bowel obstruction without hyperthermia but with fast degradation of nutritional state and water-electrolyte imbalance. The diagnosis is confirmed by imagery with duodenal dilation upstream to the obstacle with linear stop at the level of D3. The treatment is a nutritional care based on refeeding by parenteral nutrition, or by enteral way with duodenojejunostomy. Case report.- We report the case of a patient of 29 years old, thin (68 kg for 1.90 m), hospitalised for a severe craniocerebral trauma. The evolution was marked by serious neurological and infectious complications associated with progressive and important weight loss (loss of 18 kg in 4 months, BMI = 14). In this context, the patient had presented vomiting and neurological complication with intracranial hypertension was first suspected. This clinical presentation was associated with severe extracellular deshydratation. The SMAS was confirmed by abdominal scanner witch showed a gastric and duodenal distension until the space enter the mesenteric artery and the aorta, a distance between the aorta and the mesenteric artery lower than 8 mm, and an angle between this two arteries lower than 20degree. The patient was treated by parenteral nutrition with a clinical state amelioration and a progressive enteral nutrition by gastrostomy. Conclusion.- The SMAS is a rare diagnosis witch shall be thinking in front of a small bowel obstruction in thins patients in a post-resuscitation context. This complication testifies the importance of nutritional evaluation and supporting in a rehabilitation unit after intensive care stay.