A Case of Superior Mesenteric Artery Syndrome after Left Colectomy for Descending Colon Cancer

A 52-year-old woman was diagnosed as having descending colon cancer during further examination for anemia. The patient underwent a left colectomy with D3 node dissection with end-to-end anastomosis reconstruction. The accessory middle colic artery was secured as a feeding artery, and the middle colic artery was preserved. Diet was started on postoperative day 5, and nausea and vomiting appeared on postoperative day 9. An upper gastrointestinal series revealed linear cut-off in the third portion of the duodenum and dilation of the proximal duodenum. Ultrasonography and three-dimensional imaging using computed tomography revealed narrowing of the aorto-mesenteric angle. The patient was diagnosed as having aorto-mesenteric occlusion of the duodenum, and was treated with conservative therapy by continuous nasogastric decompression, total parenteral nutrition, and position change, and the symptoms gradually improved. The nasogastric tube was removed on postoperative day 23, and diet was started on postoperative day 28. The aorto-mesenteric angle after symptom improvement did not change compared with that at the onset. The postoperative course was uneventful after starting diet, and the patient was discharged on postoperative day 49. We should consider aorto-mesenteric occlusion of the duodenum in patient with a colectomy, when nausea and vomiting appears frequently and no findings suspected as ileus could be detected in the abdominal radiography during the early period after surgery.