Duodenal Derotation As an Effective Treatment of Superior Mesenteric Artery Syndrome : A Thirty-Three Year Experience
We evaluated the use of duodenal derotation as a surgical option for superior mesenteric artery syndrome (SMAS) in two groups of young patients. Sixteen patients with SMAS diagnosed by barium upper gastrointestinal series (UGI) from 1974 to 2001, and six patients diagnosed by computerized tomography...
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Veröffentlicht in: | The American surgeon 2008-07, Vol.74 (7), p.644-653 |
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description | We evaluated the use of duodenal derotation as a surgical option for superior mesenteric artery syndrome (SMAS) in two groups of young patients. Sixteen patients with SMAS diagnosed by barium upper gastrointestinal series (UGI) from 1974 to 2001, and six patients diagnosed by computerized tomography with three-dimensional reconstructions (3D CT) from 2001 to 2007 were referred to our surgical service, 19 of whom underwent duodenal derotation as the primary surgical treatment after a failed trial of conservative treatment. The main measured outcomes were the resolution of typical symptoms of SMAS and the development of long-term surgical complications. Of the first 16 patients, three (19%) responded to nasojejunal feedings. Of 13 patients undergoing derotation, only one (7.7%) failed derotation and required a gastrojejunostomy bypass, whereas 12 (92%) became asymptomatic after the derotation procedure. After a mean follow-up of 5.13 years (range 0.1-15), two patients (15%) presented with small bowel obstructions and were treated with a simple lysis of the adhesion. All six patients from 2001 to 2007 responded well to surgical derotation. Overall, duodenal derotations successfully relieved symptoms in 18 out of 19 (95%) patients with SMAS, with two (11%) major long-term surgical complications. No volvulus was observed in our patients at the mean follow-up of 4.37 years. |
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Sixteen patients with SMAS diagnosed by barium upper gastrointestinal series (UGI) from 1974 to 2001, and six patients diagnosed by computerized tomography with three-dimensional reconstructions (3D CT) from 2001 to 2007 were referred to our surgical service, 19 of whom underwent duodenal derotation as the primary surgical treatment after a failed trial of conservative treatment. The main measured outcomes were the resolution of typical symptoms of SMAS and the development of long-term surgical complications. Of the first 16 patients, three (19%) responded to nasojejunal feedings. Of 13 patients undergoing derotation, only one (7.7%) failed derotation and required a gastrojejunostomy bypass, whereas 12 (92%) became asymptomatic after the derotation procedure. After a mean follow-up of 5.13 years (range 0.1-15), two patients (15%) presented with small bowel obstructions and were treated with a simple lysis of the adhesion. All six patients from 2001 to 2007 responded well to surgical derotation. Overall, duodenal derotations successfully relieved symptoms in 18 out of 19 (95%) patients with SMAS, with two (11%) major long-term surgical complications. No volvulus was observed in our patients at the mean follow-up of 4.37 years.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/000313480807400712</identifier><identifier>PMID: 18646483</identifier><identifier>CODEN: AMSUAW</identifier><language>eng</language><publisher>Atlanta, GA: Southeastern Surgical Congress</publisher><subject>Adolescent ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Child ; Child, Preschool ; Diagnosis, Differential ; Digestive System Surgical Procedures - methods ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Duodenal Diseases - congenital ; Duodenal Diseases - diagnostic imaging ; Duodenal Diseases - surgery ; Duodenum - abnormalities ; Duodenum - surgery ; Female ; Follow-Up Studies ; General aspects ; Humans ; Imaging, Three-Dimensional ; Infant ; Male ; Medical imaging ; Medical sciences ; Medical treatment ; Patients ; Postoperative Complications ; Retrospective Studies ; Spinal cord injuries ; Superior Mesenteric Artery Syndrome - diagnostic imaging ; Superior Mesenteric Artery Syndrome - etiology ; Superior Mesenteric Artery Syndrome - surgery ; Time Factors ; Tomography, X-Ray Computed - methods ; Treatment Outcome ; Veins & arteries</subject><ispartof>The American surgeon, 2008-07, Vol.74 (7), p.644-653</ispartof><rights>2008 INIST-CNRS</rights><rights>Copyright Southeastern Surgical Congress Jul 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c402t-da2d46eb9ff3171b71562387a080969cbfa6b5e1909ffd1a73844d1bbad66b363</citedby><cites>FETCH-LOGICAL-c402t-da2d46eb9ff3171b71562387a080969cbfa6b5e1909ffd1a73844d1bbad66b363</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20460247$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18646483$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HA, Chi D</creatorcontrib><creatorcontrib>ALVEAR, Domingo T</creatorcontrib><creatorcontrib>LEBER, David C</creatorcontrib><title>Duodenal Derotation As an Effective Treatment of Superior Mesenteric Artery Syndrome : A Thirty-Three Year Experience</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>We evaluated the use of duodenal derotation as a surgical option for superior mesenteric artery syndrome (SMAS) in two groups of young patients. Sixteen patients with SMAS diagnosed by barium upper gastrointestinal series (UGI) from 1974 to 2001, and six patients diagnosed by computerized tomography with three-dimensional reconstructions (3D CT) from 2001 to 2007 were referred to our surgical service, 19 of whom underwent duodenal derotation as the primary surgical treatment after a failed trial of conservative treatment. The main measured outcomes were the resolution of typical symptoms of SMAS and the development of long-term surgical complications. Of the first 16 patients, three (19%) responded to nasojejunal feedings. Of 13 patients undergoing derotation, only one (7.7%) failed derotation and required a gastrojejunostomy bypass, whereas 12 (92%) became asymptomatic after the derotation procedure. After a mean follow-up of 5.13 years (range 0.1-15), two patients (15%) presented with small bowel obstructions and were treated with a simple lysis of the adhesion. All six patients from 2001 to 2007 responded well to surgical derotation. Overall, duodenal derotations successfully relieved symptoms in 18 out of 19 (95%) patients with SMAS, with two (11%) major long-term surgical complications. No volvulus was observed in our patients at the mean follow-up of 4.37 years.</description><subject>Adolescent</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Diagnosis, Differential</subject><subject>Digestive System Surgical Procedures - methods</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Duodenal Diseases - congenital</subject><subject>Duodenal Diseases - diagnostic imaging</subject><subject>Duodenal Diseases - surgery</subject><subject>Duodenum - abnormalities</subject><subject>Duodenum - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General aspects</subject><subject>Humans</subject><subject>Imaging, Three-Dimensional</subject><subject>Infant</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Medical treatment</subject><subject>Patients</subject><subject>Postoperative Complications</subject><subject>Retrospective Studies</subject><subject>Spinal cord injuries</subject><subject>Superior Mesenteric Artery Syndrome - diagnostic imaging</subject><subject>Superior Mesenteric Artery Syndrome - etiology</subject><subject>Superior Mesenteric Artery Syndrome - surgery</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Treatment Outcome</subject><subject>Veins & arteries</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNplkU9v1DAQxS1ERZelX4ADspDoLcVjO7bDbdUuUKkVhy6HniLHGaupknixk4r99nXUFUhwmj_6vZHmPULeA7sA0PozY0yAkIYZpiVjGvgrsoKyLIvKcPGarBagWIhT8jalxzxKVcIbcgpGSSWNWJH5ag4tjranVxjDZKcujHSTqB3p1nt0U_eEdBfRTgOOEw2e3s17jF2I9BZTXuXe0U3M9UDvDmMbw4D0C93Q3UMXp0Oxe4iI9B5tpNvfixJHh-_Iibd9wrNjXZOfX7e7y-_FzY9v15ebm8JJxqeitbyVCpvKewEaGg2l4sJomz-uVOUab1VTIlQsEy1YLYyULTSNbZVqhBJrcv5ydx_DrxnTVA9dctj3dsQwp1pVQhiTjViTj_-Aj2GO2ZZUc-CGa1ALxF8gF0NKEX29j91g46EGVi-J1P8nkkUfjpfnZsD2r-QYQQY-HQGbnO19tKPr0h-O58wYl1o8A1j0knw</recordid><startdate>20080701</startdate><enddate>20080701</enddate><creator>HA, Chi D</creator><creator>ALVEAR, Domingo T</creator><creator>LEBER, David C</creator><general>Southeastern Surgical Congress</general><general>SAGE PUBLICATIONS, INC</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20080701</creationdate><title>Duodenal Derotation As an Effective Treatment of Superior Mesenteric Artery Syndrome : A Thirty-Three Year Experience</title><author>HA, Chi D ; ALVEAR, Domingo T ; LEBER, David C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c402t-da2d46eb9ff3171b71562387a080969cbfa6b5e1909ffd1a73844d1bbad66b363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Diagnosis, Differential</topic><topic>Digestive System Surgical Procedures - methods</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Duodenal Diseases - congenital</topic><topic>Duodenal Diseases - diagnostic imaging</topic><topic>Duodenal Diseases - surgery</topic><topic>Duodenum - abnormalities</topic><topic>Duodenum - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General aspects</topic><topic>Humans</topic><topic>Imaging, Three-Dimensional</topic><topic>Infant</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Medical treatment</topic><topic>Patients</topic><topic>Postoperative Complications</topic><topic>Retrospective Studies</topic><topic>Spinal cord injuries</topic><topic>Superior Mesenteric Artery Syndrome - diagnostic imaging</topic><topic>Superior Mesenteric Artery Syndrome - etiology</topic><topic>Superior Mesenteric Artery Syndrome - surgery</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Treatment Outcome</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>HA, Chi D</creatorcontrib><creatorcontrib>ALVEAR, Domingo T</creatorcontrib><creatorcontrib>LEBER, David C</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HA, Chi D</au><au>ALVEAR, Domingo T</au><au>LEBER, David C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Duodenal Derotation As an Effective Treatment of Superior Mesenteric Artery Syndrome : A Thirty-Three Year Experience</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2008-07-01</date><risdate>2008</risdate><volume>74</volume><issue>7</issue><spage>644</spage><epage>653</epage><pages>644-653</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><coden>AMSUAW</coden><abstract>We evaluated the use of duodenal derotation as a surgical option for superior mesenteric artery syndrome (SMAS) in two groups of young patients. Sixteen patients with SMAS diagnosed by barium upper gastrointestinal series (UGI) from 1974 to 2001, and six patients diagnosed by computerized tomography with three-dimensional reconstructions (3D CT) from 2001 to 2007 were referred to our surgical service, 19 of whom underwent duodenal derotation as the primary surgical treatment after a failed trial of conservative treatment. The main measured outcomes were the resolution of typical symptoms of SMAS and the development of long-term surgical complications. Of the first 16 patients, three (19%) responded to nasojejunal feedings. Of 13 patients undergoing derotation, only one (7.7%) failed derotation and required a gastrojejunostomy bypass, whereas 12 (92%) became asymptomatic after the derotation procedure. After a mean follow-up of 5.13 years (range 0.1-15), two patients (15%) presented with small bowel obstructions and were treated with a simple lysis of the adhesion. All six patients from 2001 to 2007 responded well to surgical derotation. Overall, duodenal derotations successfully relieved symptoms in 18 out of 19 (95%) patients with SMAS, with two (11%) major long-term surgical complications. No volvulus was observed in our patients at the mean follow-up of 4.37 years.</abstract><cop>Atlanta, GA</cop><pub>Southeastern Surgical Congress</pub><pmid>18646483</pmid><doi>10.1177/000313480807400712</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Child Child, Preschool Diagnosis, Differential Digestive System Surgical Procedures - methods Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Duodenal Diseases - congenital Duodenal Diseases - diagnostic imaging Duodenal Diseases - surgery Duodenum - abnormalities Duodenum - surgery Female Follow-Up Studies General aspects Humans Imaging, Three-Dimensional Infant Male Medical imaging Medical sciences Medical treatment Patients Postoperative Complications Retrospective Studies Spinal cord injuries Superior Mesenteric Artery Syndrome - diagnostic imaging Superior Mesenteric Artery Syndrome - etiology Superior Mesenteric Artery Syndrome - surgery Time Factors Tomography, X-Ray Computed - methods Treatment Outcome Veins & arteries |
title | Duodenal Derotation As an Effective Treatment of Superior Mesenteric Artery Syndrome : A Thirty-Three Year Experience |
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