Superior mesenteric artery syndrome
Description
◉ Profile of the Patient
• Age/Sex: male, age 22
• Build: Asthenic (underweight and slender)
• Overview: A young man with persistent complaints of upper gastrointestinal blockage.
◉ Presenting Complaints
• For eight months, there has been recurring stomach pain.
• Colicky by nature
• precipitated following a meal.
• After vomiting undigested food, I felt relieved.
• Distension and fullness in the epigastrium following meals
• Regular vomiting that contains undigested food and is not bilious
• Weight loss that happens gradually
• Time frame: eight months
• Related characteristics: There were no reports of melena, hematemesis, or jaundice.
◉ Historical Background
• An intestinal blockage episode that occurred a month ago was treated conservatively with symptomatic measures.
• No prior history of major surgery, peptic ulcer disease, or tuberculosis.
• There are no notable comorbidities.
◉ Physical Examination
• Overall health: Undernourished, thin-built, and hemodynamically stable.
• Vital signs: stable, with normal blood pressure, temperature, and pulse.
◉ Examining the abdomen:
• Epigastric fullness that is visible (indicating dilation of the upper GIT)
• loud hyperperistaltic bowel noises that could indicate proximal obstruction
• No compassion or protection
• No organomegaly or palpable bulk
◉ Routine Investigations
• Blood tests: Normal liver function, electrolyte levels, and complete blood count.
• Examination of the urine: Normal.
• TB Montoux test: Negative.
• Erythrocyte sedimentation rate (ESR): Normal; no signs of inflammation or persistent infection are present.
• Ultrasonography (USG): Normal, with no fluid or bulk inside the abdomen.
• Barium Meal Completion
◉ Results:
• significant dilatation of the duodenum's second section and stomach.
• abrupt discontinuity at the duodenum's third segment.
• no inherent abnormalities of the mucosa.
• No alleviation of blockage in the prone position or left lateral decubitus, which typically lessens moderate compression.
• Interpretation: Consistent with SMAS, it suggests extrinsic compression at the third segment of the duodenum.
• Abdomen Contrast-Enhanced CT (CECT)
◉ Results:
• severe stomach and duodenal distention in the first and second sections.
• compression of the duodenum's third section between the aorta and the superior mesenteric artery (SMA) in the back.
• No wall thickening or intrinsic lesion.
• validates the SMA Syndrome diagnosis.
◉ Anatomical association:
• SMA typically exits the aorta at an angle between 25° and 60°, separated by 10–28 mm.
• In this patient, compression resulted from the angle decreasing to roughly 6° to 15° and the distance to 2 to 8 mm as a result of the loss of retroperitoneal fat.
Protocol
◉ Conservative Administration (First Step)
• Time frame: one month
◉ Measures advised:
• To avoid postprandial distension, consume a healthy liquid diet in modest portions on a regular basis.
• To lessen duodenal compaction, postural therapy involves lying prone or in a left lateral position after meals.
• Metoclopramide is a prokinetic medication that improves stomach emptying.
• Outcome: Prolonged fullness and vomiting with no improvement in symptoms.
• Decision: Move forward with the surgical procedure.
• Surgical Procedure a. Intervention
• laparotomy exploratory by midline incision.
◉ Postoperative Course
• Recuperation: Not much happened.
• Day 4: Oral liquids were started, and then a soft and regular diet was gradually introduced.
◉ Follow-up:
• put on weight.
• No pain or vomiting has returned.
• Symptom-free and able to tolerate regular meals
◉ Intraoperative results:
• Proximal duodenum and stomach distention (2nd portion).
• SMA-aortic angle-induced extrinsic compression of the duodenum's third segment.
• little mesenteric lymph nodes and mild peritoneal adhesions.
• Actions to take:
• separation of adhesions, or adhesiolysis.
• biopsy of a mesenteric lymph node (insignificant).
• To get around the squeezed portion, a retrocolic duodenojejunostomy (side-to-side anastomosis) was done.
◉ NURSING MANAGEMENT:
• Problems Faced by AMI Patients and Nursing Interventions
• Problem: Hemodynamic Instability and Risk of Complications
• Management:
• Monitoring of vital signs (blood pressure, heart rate, respiratory rate, and oxygen saturation) and immediate stabilization.
• Nursing Intervention:
• Give aspirin and thrombolytic medication as directed, start cardiac monitoring, and administer oxygen therapy.
• Stabilizing the patient's condition and avoiding arrhythmias or hemodynamic decline are the goals.
• The role of the nurse is to continuously and carefully screen for early warning indicators and accurately document clinical changes to enable timely treatments.
• Pain and psychological distress (depression, anxiety, and fear) are the issue.
• Management:
• The evaluation and treatment of pain with pharmaceuticals such as morphine and nitroglycerin.
• Nursing Intervention:
• Use cognitive therapy methods, relaxation techniques, and active listening to offer psychological support.
• The goal is to lessen mental strain and pain, which can exacerbate heart workload.
• Nursing Role:
• Build trust, reassure patients, provide emotional support, help patients develop coping mechanisms.
• Issue: Insufficient Patient and Family Understanding of AMI and Its Treatment
• Management:
• Instruction on the course of the illness, how to identify symptoms, how to take medications as prescribed, and how to modify one's diet and exercise routine.
• Nursing Intervention:
• Personalized instruction through the use of self-care journals, smoking cessation counseling, dietary changes, and physical exercise.
• The goal is to increase compliance, lower the risk of recurrence, and enhance self-management.
• Nursing Role: Educate and assist family members to strengthen adherence to care after discharge.
• Issue: Long-Term Complications and Readmission Risk
• Management:
• Support for lifestyle changes, follow-up care, and customized discharge planning.
• Nursing Intervention:
• Put in place regimented workouts and offer continuing assistance with taking medications as prescribed.
• The role of a nurse is to check compliance, coordinate post-discharge care, and offer psychosocial support.
• Problem: Risk of Readmission and Long-Term Complications
• Management:
• Support for lifestyle changes, follow-up care, and customized discharge planning.
• Nursing Intervention:
• Put in place regimented workouts and offer continuing assistance with taking medications as prescribed.
• The goal is to decrease readmissions to hospitals and enhance long-term results.
• The role of a nurse is to check compliance, coordinate post-discharge care, and offer psychosocial support.
Notes
FOR MORE DETAILS VISIT: https://pmc.ncbi.nlm.nih.gov/articles/PMC3339065/?utm_source=chatgpt.com
