Diagnosis and treatment of superior mesenteric artery compression syndrome secondary to chronic constipation (Lee′s triad syndrome)
10.3760/cma.j.issn.1671-0274.2020.01.008
- VernacularTitle: 慢性便秘继发肠系膜上动脉压迫综合征（李氏三联征）的诊断与治疗
- Author:
Qiyi CHEN
1
;
Hongliang TIAN
1
;
Bo YANG
1
;
Zhiliang LIN
1
;
Di ZHAO
1
;
Chunlian MA
1
;
Xia CHEN
1
;
Jun JIANG
2
;
Huanlong QIN
1
;
Ning LI
1
,
3
Author Information
1. Department of Colorectal and Anal Surgery, the Tenth People′s Hospital, Tongji University, Shanghai 200072, China
2. Research Institute of General Surgery, General Hospital of Eastern Theater Command, Nanjing 210002, China
3. Research Institute of General Surgery, General Hospital of Eastern Theater Command, Nanjing 210002, China
- Publication Type:Journal Article
- Keywords:
Chronic constipation;
Superior mesenteric artery compression syndrome;
Malnutrition;
Fecal microbiota transplantation;
Lee′s triad Syndrome
- From:
Chinese Journal of Gastrointestinal Surgery
2020;23(1):44-50
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the experience of diagnosis and treatment of superior mesenteric artery compression syndrome (SMACS) secondary to chronic constipation according to the concept of Lee′s triad syndrome.
Methods:The concept of Lee′s triad syndrome: (1) clinical symptoms: triad of constipation, malnutrition, upper gastrointestinal obstruction (vomiting, difficulty in eating); (2) anatomical manifestations: with triple anatomy anomaly of transverse colon sagging, elevated spleen flexure, and mesentery arterial compression; (3) treatment: with triple treatment of enteral nutrition support, chest-knee posture and fecal microbiota transplantation. A descriptive cohort study was performed. According to Lee′s triad syndrome criteria, clinical data of 78 patients with superior mesenteric artery compression syndrome secondary to chronic constipation in the Tenth People′s Hospital of Tongji University and General Hospital of Eastern Theater Command from June 2004 to November 2018 were prospectively collected, including basic information, symptoms and signs, imaging findings, nutritional indicators, gastrointestinal quality of life index (GIQLI) and Wexner defecation score. The above parameters based on Lee′s triad syndrome criteria were followed up and recorded at 1, 3, 6, 12 months after comprehensive treatment.
Results:All the patients had Lee′s triple symptoms of constipation, malnutrition, upper gastrointestinal obstruction (vomiting, eating difficulties), and triple anatomy anomaly of transverse colon sagging, elevated spleen curvature, and mesentery arterial compression before treatment. After triple treatment of enteral nutrition support, chest-knee posture, and fecal microbiota transplantation, 69 (88.5%) patients had a significant improvement of symptoms, and 9 patients had no significant improvement of symptoms and then eventually received surgery. The 69 cases without operation received follow-up for 12 months. All the patients eventually returned to normal eating, and upper gastrointestinal angiography and superior mesenteric artery imaging showed duodenal compression disappeared. After 1 month, the constipation-related indexes were improved. After 12 months, the number of autonomous defecation per week increased from 1.0±0.8 to 5.0±1.6 (P<0.001). The GIQLI score increased from 52.7±8.5 to 93.2±7.5 (P<0.001), and the Wexner score decreased from 19.1±2.5 to 6.2±2.1 (P<0.001). After 1 month, nutritional indexes were improved gradually. After 12 months, the BMI increased from (17.9±1.8) kg/m2 to (21.0±1.3) kg/m2, total protein increased from (65.2±5.7) g/L to (68.3±4.2) g/L, albumin increased from (32.1±5.1) g/L to (40.4±3.0) g/L, prealbumin increased from (163.2±53.7) mg/L to (259.1±45.6) mg/L, fibrinogen increased from (1.9±0.5) g/L to (2.4±0.5) g/L, whose differences were statistically significant (all P<0.001). Upper gastrointestinal angiography and superior mesenteric artery imaging showed duodenal compression were relieved. The angle between superior mesenteric artery and abdominal aorta increased from (17.4±3.8)° to (37.8±5.8)° (t=-22.26, P<0.001).
Conclusion:When patients with SMACS secondary to chronic constipation have Lee′s triple symptoms and triple anatomy anomaly, the triple combination treatment of enteral nutrition support, chest-knee posture and fecal microbiota transplantation should be applied.
