Volume 186 - Issue 1
Superior mesenteric artery syndrome with hepatic portal venous gas
Authors: Chi-Lun Tsai, Ming-Jenn Chen, Che-Kim Tan, Khee-Siang Chan and Kuo-Chen Cheng
Med J Aust 2007; 186 (1): 48. || doi: 10.5694/j.1326-5377.2007.tb00794.x
Published online: 1 January 2007
Published online: 1 January 2007
A 17-year-old man with a slim build presented with recurrent postprandial epigastric fullness and bilious vomiting. He was acutely unwell. An abdominal radiograph showed gastric and duodenal distension. Contrast computed tomography scans showed proximal duodenal dilatation (Box, A, arrow), with a triangular-shaped duodenum, extensive hepatic portal venous gas (Box, B, arrows), and a massively distended stomach.
Superior mesenteric artery syndrome with hepatic portal venous gas was diagnosed. This syndrome occurs when the fat pad between the superior mesenteric artery and its origin at the aorta is lost, causing a sharp, narrow angle at the aortomesentery junction. The third portion of the duodenum is compressed and becomes obstructed when passing through this angle.1 Hepatic portal venous gas can develop as a result of bowel ischaemia.
Surgical therapy with duodenojejunostomy is the treatment of choice for a severely ill patient, or when more conservative treatment has failed.2
References
- Cohen LB, Field SP, Sachar DB. The superior mesenteric artery syndrome. The disease that isn’t, or is it? J Clin Gastroenterol 1985; 7: 113-116.
- Ylinen P, Kinnunen J, Hockerstedt K. Superior mesenteric artery syndrome. A follow-up study of 16 operated patients. J Clin Gastroenterol 1989; 11: 386-391. 0_i1091798
Non-Technical Errors Associated With Deaths in Surgical Care, Australia, 2012–2019, by Surgical Specialty (Australian and New Zealand Audit of Surgical Mortality)
Jesse Ey, Guy J. Maddern
Localised Herpes Simplex Following Midline Laparotomy
Jessica S. Bulluss, Paul Chee, Matthew J. Verheyden
Non‐technical errors associated with deaths in surgical care, Australia, 2012–2019, by surgical specialty (Australian and New Zealand Audit of Surgical Mortality): a retrospective cohort study
Jesse Ey, Victoria Kollias, Octavia Lee, Kelly Hou, Matheesha Herath, John B North, Ellie Treloar, Suzanne Edwards, Martin Bruening, Adam J Wells, Guy J Maddern
Changes in patient management after preoperative MRI for newly diagnosed breast cancer: a multicentre prospective observational study
Michael L Marinovich, Nehmat Houssami, Andrew Spillane, Gregory B Mann, Donna Taylor, Michelle Reintals, Nadine Phillips, Max K Bulsara, Patsy Siok Hwa Soon, Tracey Dickens, Christobel M Saunders
The first Australian evidence‐based guidelines on male infertility
Darren J Katz, Liza O’Donnell, Robert I McLachlan, Tim J Moss, Clare V Boothroyd, Veena Jayadev, Sarah R Catford
The first live term birth following uterus transplantation in Australia
Rebecca Deans, Brigitte Gerstl, Antonia W Shand, Sarah Lyons, Aaron Budden, Helen L Barrett, Grant Luxton, Mangalee Fernando, Kenneth Yong, Karen Keung, Kaushalya Arulpragasam, Henry Pleass, King Man Wan, Eva Kehag, Jana‐Emily Pittman, Mianna Lotz, Maria Fenn, Erin Nesbitt‐Hawes, Lily Byun, Katrina Tang, Mats Brannstrom, Jason Abbott