Teenager with upper gastrointestinal obstruction – keep in mind the rare causes
Introduction. Superior mesenteric artery syndrome is a rare cause of upper gastrointestinal tract obstruction. Case presentation. A 17-year-old adolescent is admitted in the Pediatrics Department of “Grigore Alexandrescu” Hospital in Bucharest in July 2018 for episodes of vomiting associated with...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Amaltea Medical Publishing House
2019-12-01
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| Series: | Romanian Journal of Pediatrics |
| Subjects: | |
| Online Access: | https://rjp.com.ro/articles/2019.4/RJP_2019_4_EN_Art-08.pdf |
| _version_ | 1811335286432464896 |
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| author | Livia E. Brezeanu Oana M. Guta Raluca M. Vlad Anatolie Nidelcu Mirela Pavelescu Daniela Pacurar |
| author_facet | Livia E. Brezeanu Oana M. Guta Raluca M. Vlad Anatolie Nidelcu Mirela Pavelescu Daniela Pacurar |
| author_sort | Livia E. Brezeanu |
| collection | DOAJ |
| description | Introduction. Superior mesenteric artery syndrome is a rare cause of upper gastrointestinal tract obstruction.
Case presentation. A 17-year-old adolescent is admitted in the Pediatrics Department of “Grigore Alexandrescu”
Hospital in Bucharest in July 2018 for episodes of vomiting associated with epigastric pain. The patient started presenting persistent abdominal pain since five years before, apparently after an appendectomy. In the last year, he associated heartburn, dysgeusia, food vomiting and postprandial plenitude. A diagnosis of H. pylori acute gastritis was initially set and he received triple therapy with temporary relief. Due to chronic digestive symptoms, the adolescent presented anxiety related to food intake with extremely reduced appetite, food selectivity and lack of weight gain.
The clinical examination revealed marfanoid phenotype, low weight, chest deformity, excavated abdomen, epigastric pain and clapotage. Laboratory investigations were within normal limits. Esogastroduodenal barium examination showed an important gastric stasis with an elongated stomach, dilation of the second part of the duodenum with delayed distal passage. Abdominal ultrasound revealed reduced aorto-mesenteric distance at the third part of the duodenum. Upper gastrointestinal endoscopy found barium residue in the stomach 24 hours after the contrast study and a spastic pylorus, with impossible safe duodenal passage. Abdominal computed tomography confirmed obstruction of the third part of the duodenum by vascular compression at the aorto-mesenteric angle, a specific image for superior mesenteric artery syndrome. The patient underwent laparoscopic surgery with a good outcome.
Conclusions. Although a rare entity, duodenal obstruction by aorto-mesenteric clamp must be taken into account in the differential diagnosis of vomiting. An early radiologic diagnostic spares the patient of chronic digestive disease with negative impact on nutritional status and quality of life. |
| first_indexed | 2024-04-13T17:21:54Z |
| format | Article |
| id | doaj.art-ff47aaa8704447e5a33d42d80b9893f7 |
| institution | Directory Open Access Journal |
| issn | 1454-0398 2069-6175 |
| language | English |
| last_indexed | 2024-04-13T17:21:54Z |
| publishDate | 2019-12-01 |
| publisher | Amaltea Medical Publishing House |
| record_format | Article |
| series | Romanian Journal of Pediatrics |
| spelling | doaj.art-ff47aaa8704447e5a33d42d80b9893f72022-12-22T02:37:58ZengAmaltea Medical Publishing HouseRomanian Journal of Pediatrics1454-03982069-61752019-12-0168426827210.37897/RJP.2019.4.8Teenager with upper gastrointestinal obstruction – keep in mind the rare causesLivia E. Brezeanu0Oana M. Guta1Raluca M. Vlad2Anatolie Nidelcu3Mirela Pavelescu4Daniela Pacurar5“Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Romania “Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Romania “Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania“Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Romania “Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania“Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, RomaniaIntroduction. Superior mesenteric artery syndrome is a rare cause of upper gastrointestinal tract obstruction. Case presentation. A 17-year-old adolescent is admitted in the Pediatrics Department of “Grigore Alexandrescu” Hospital in Bucharest in July 2018 for episodes of vomiting associated with epigastric pain. The patient started presenting persistent abdominal pain since five years before, apparently after an appendectomy. In the last year, he associated heartburn, dysgeusia, food vomiting and postprandial plenitude. A diagnosis of H. pylori acute gastritis was initially set and he received triple therapy with temporary relief. Due to chronic digestive symptoms, the adolescent presented anxiety related to food intake with extremely reduced appetite, food selectivity and lack of weight gain. The clinical examination revealed marfanoid phenotype, low weight, chest deformity, excavated abdomen, epigastric pain and clapotage. Laboratory investigations were within normal limits. Esogastroduodenal barium examination showed an important gastric stasis with an elongated stomach, dilation of the second part of the duodenum with delayed distal passage. Abdominal ultrasound revealed reduced aorto-mesenteric distance at the third part of the duodenum. Upper gastrointestinal endoscopy found barium residue in the stomach 24 hours after the contrast study and a spastic pylorus, with impossible safe duodenal passage. Abdominal computed tomography confirmed obstruction of the third part of the duodenum by vascular compression at the aorto-mesenteric angle, a specific image for superior mesenteric artery syndrome. The patient underwent laparoscopic surgery with a good outcome. Conclusions. Although a rare entity, duodenal obstruction by aorto-mesenteric clamp must be taken into account in the differential diagnosis of vomiting. An early radiologic diagnostic spares the patient of chronic digestive disease with negative impact on nutritional status and quality of life.https://rjp.com.ro/articles/2019.4/RJP_2019_4_EN_Art-08.pdfvomitingduodenal obstructionmarfanoid phenotypeaorto-mesenteric clamp |
| spellingShingle | Livia E. Brezeanu Oana M. Guta Raluca M. Vlad Anatolie Nidelcu Mirela Pavelescu Daniela Pacurar Teenager with upper gastrointestinal obstruction – keep in mind the rare causes Romanian Journal of Pediatrics vomiting duodenal obstruction marfanoid phenotype aorto-mesenteric clamp |
| title | Teenager with upper gastrointestinal obstruction – keep in mind the rare causes |
| title_full | Teenager with upper gastrointestinal obstruction – keep in mind the rare causes |
| title_fullStr | Teenager with upper gastrointestinal obstruction – keep in mind the rare causes |
| title_full_unstemmed | Teenager with upper gastrointestinal obstruction – keep in mind the rare causes |
| title_short | Teenager with upper gastrointestinal obstruction – keep in mind the rare causes |
| title_sort | teenager with upper gastrointestinal obstruction keep in mind the rare causes |
| topic | vomiting duodenal obstruction marfanoid phenotype aorto-mesenteric clamp |
| url | https://rjp.com.ro/articles/2019.4/RJP_2019_4_EN_Art-08.pdf |
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