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Gastrointestinal Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Justine Turner, Sally Schwartz
Superior mesenteric artery (SMA) syndrome is a rare condition that occurs when the duodenum is compressed between the aorta and a branch of the SMA. The most common cause of this condition is significant weight loss and also after surgery for scoliosis. In individuals with weight loss, the normal fat pad shrinks and causes the angle of the SMA to change, now putting pressure on the intestine.
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Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Haematocolpos is a rare condition caused by the onset of menstruation with an imperforate hymen. Blood accumulates in the vagina and may eventually cause swelling of the uterus and even the fallopian tubes. This may manifest itself as a mass, which may extend into the pelvis and be felt transabdominally. Urinary hesitancy and frequency due to pressure from the mass may follow. Dissection of the membrane under general anaesthetic results in a release of the collected blood and subsequent relief from the symptoms. Wilkie’s syndrome is a rare syndrome that may cause acute or chronic abdominal pain in children and adults. The third part of the duodenum is compressed between the superior mesenteric artery and the aorta, resulting in symptoms of upper gastrointestinal obstruction.
Exposure for spinal surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The majority of postoperative complications are related to the respiratory system. A review of 505 children who had an anterior spinal exposure reported a 9.8% overall complication rate with half of the complications being respiratory in nature, including effusions, pneumothoraces, atelectasis, and respiratory failure. Gastrointestinal complications included superior mesenteric artery syndrome, which resolved with conservative management (parenteral nutrition or use of a nasojejunal feeding tube), and gastrointestinal bleeding. The other complications reported in this review were vessel injuries at the time of the exposure and urinary tract infections. A more recent review of over 19 000 children with scoliosis surgery revealed fewer but similar complications, with a 1% incidence of neurologic and pulmonary complications, and a 2.3% risk of a wound infection.
The relationship of foetal superior mesenteric artery blood flow and the time to first meconium passage in newborns with late-onset foetal growth restriction
Published in Journal of Obstetrics and Gynaecology, 2022
Melih Velipasaoğlu, Ozge Surmeli Onay, Adviye Cakil Saglık, Ozge Aydemir, Huseyin Mete Tanır, Ayşe Neslihan Tekin
The pregnant women who agreed to participate in the study were evaluated twice weekly with Doppler ultrasound and biophysical profile scoring. The Doppler velocimetry parameters including PI and resistance index (RI) of UA, MCA and SMA, cerebroplacental ratio (CPR) (MCA PI/UA PI) and the ratios of UA PI/SMA PI, MCA PI/SMA PI were studied in each examination and percentiles according to the gestational weeks were noted (Ebbing et al. 2007; Ebbing et al. 2009b; Kivilevitch et al. 2011). Umbilical artery Doppler acquisitions were made from free loop of the umbilical cord. Middle cerebral artery was located by colour Doppler in the Willis polygon and acquisitions were performed from the proximal part of the MCA. To identify the SMA, in sagittal plane of the foetus Doppler frame was placed on the abdominal aorta and two unpaired branches of abdominal aorta were visualised: truncus coeliacus and SMA. Superior mesenteric artery is placed caudally to the truncus coeliacus.
Nutritional management of a polytrauma patient in an intensive care unit
Published in South African Journal of Clinical Nutrition, 2021
An ongoing, unexplained and inconsistent pattern of vomiting provided another major challenge, developing on day 17 and persisting until day 38 post-injury. There was no evidence of abdominal sepsis and the surgeons saw no need for further surgery. When investigations such as a gastroscopy and a gastrograffin challenge yielded normal results, and prokinetics did not provide consistent relief, the surgeons considered superior mesenteric artery syndrome (SMAS) as the possible cause of the clinical picture. Computed tomography (CT) angiography was unremarkable. Feeding varied from exclusive PN, to PN and trophic nasogastric feeds, to PN and oral nutritional supplements (ONS) over the course of four weeks. Chewing gum was given to stimulate peristalsis. While recommendations for the management of SMA syndrome and enteral intolerance include post-pyloric feeding as well as PN, the facility experienced a temporary shortage of naso-jejunal tubes and PN remained the primary feeding route.2,5 To alleviate the patient’s notable muscle wasting, he was given testosterone injections of 200 mg on days 25, 32 and 40.
Does transverse colon cancer spread to the extramesocolic lymph node stations?
Published in Acta Chirurgica Belgica, 2021
Bulent C. Yuksel, Sadettin ER, Erdinç Çetinkaya, Ahmet Keşşaf Aşlar
Although CME and CVL can be applied to all colon cancers, these procedures are slightly different in transverse colon cancers. The transverse colon shows embryological and anatomical oddities due to its midgut and hindgut origin and the location between the foregut and midgut-hindgut. The proximal 2/3 part is the end of the midgut while the distal part is the beginning of the hindgut. The proximal portion of the superior mesenteric artery and the foregut components, such as the great omentum, pancreas and lesser sac, are intertwined. This convoluted relationship suggests the possibility of an interaction between embryological areas. This relationship is even more evident in the venous drainage of the omentum and pancreas. These connections between embryological planes were described by Stelzner et al. in cadaveric studies [12]. In their prospective analysis, Perrakis et al. demonstrated tumor manifestation extending beyond this embryological area [13].