Behçet’s disease (BD) is a multisystemic, chronic autoimmune inflammatory vasculitic disease with an unknown etiology. Although the literature reports that vascular involvement occurs in 7% to 38% of all BD cases, the arteries are rarely involved; however, arterial involvement is usually associated with significant mortality and morbidity. We report the case of a young female patient who presented to the emergency department with severe abdominal pain and a history of weight loss. The patient was evaluated using computed tomography angiography, which revealed a ruptured suprarenal aortic pseudoaneurysm with occlusion of both the superior mesenteric and celiac arteries. Urgent surgery was performed with aortic repair with an interposition graft and superior mesenteric artery embolectomy. The patient’s clinical history and radiological imaging findings were strongly suggestive of the diagnosis of BD with vascular involvement.
Abdominal Pain ; Aneurysm, False ; Angiography ; Arteries ; Behcet Syndrome ; Celiac Artery ; Diagnosis ; Embolectomy ; Emergency Service, Hospital ; Female ; Humans ; Mesenteric Artery, Superior ; Mortality ; Transplants ; Vasculitis ; Weight Loss

Abdominal Pain ; diagnosis ; Adult ; Female ; Humans ; Sports ; Superior Mesenteric Artery Syndrome ; diagnosis ; Young Adult

Zollinger-Ellison syndrome (ZES) is characterized by gastrinoma and resultant hypergastrinemia, which leads to recurrent peptic ulcers. Because gastrinoma is the most common pancreatic endocrine tumor seen in multiple endocrine neoplasia type I (MEN 1), the possibility of gastrinoma should be investigated carefully when patients exhibit symptoms associated with hormonal changes. Ureteral stones associated with hyperparathyroidism in the early course of MEN 1 are known to be its most common clinical manifestation; appropriate evaluation and close follow-up of patients with hypercalcemic urolithiasis can lead to an early diagnosis of gastrinoma. We report a patient with ZES associated with MEN 1, and urolithiasis as the presenting entity. A 51-year-old man visited the emergency department with recurrent epigastric pain. He had a history of calcium urinary stone 3 years ago, and 2 years later he had 2 operations for multiple jejunal ulcer perforations; these surgeries were 9 months apart. He was taking intermittent courses of antiulcer medication. Multiple peripancreatic nodular masses, a hepatic metastasis, parathyroid hyperplasia, and a pituitary microadenoma were confirmed by multimodal imaging studies. We diagnosed ZES with MEN 1 and performed sequential surgical excision of the gastrinomas and the parathyroid adenoma. The patient received octreotide injection therapy and close follow-up.
Gastrinoma/metabolism/pathology/ultrasonography ; Gastrins/metabolism ; Humans ; Immunohistochemistry ; Liver/radiography ; Magnetic Resonance Imaging ; Male ; Mesenteric Artery, Superior/radiography ; Middle Aged ; Multimodal Imaging ; Multiple Endocrine Neoplasia Type 1/complications/*diagnosis/radiography ; Pancreas/radiography/radionuclide imaging ; Pituitary Gland/radiography ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Thyroid Gland/ultrasonography ; Tomography, X-Ray Computed ; Urolithiasis/*diagnosis/etiology ; Zollinger-Ellison Syndrome/complications/*diagnosis

No abstract available.
Aged ; Constriction, Pathologic ; Diagnosis, Differential ; Female ; Humans ; Jejunum/pathology ; Mesenteric Artery, Superior/*pathology/radiography/surgery ; Stents ; Superior Mesenteric Artery Syndrome/diagnosis/radiography ; Thrombosis/radiography/surgery ; Tomography, X-Ray Computed

The aim of this study was to investigate the outcome, and optimal duration of medical treatment in children with superior mesenteric artery syndrome (SMAS). Eighteen children with SMAS were retrospectively studied. The data reviewed included demographics, presenting symptoms, co-morbid conditions, clinical courses, nutritional status, treatments, and outcomes. The three most common symptoms were postprandial discomfort (67.7%), abdominal pain (61.1%), and early satiety (50%). The median duration of symptoms before diagnosis was 68 days. The most common co-morbid condition was weight loss (50%), followed by growth spurt (22.2%) and bile reflux gastropathy (16.7%). Body mass index (BMI) was normal in 72.2% of the patients. Medical management was successful in 13 patients (72.2%). The median duration of treatment was 45 days. Nine patients (50%) had good outcomes without recurrence, 5 patients (27.8%) had moderate outcomes, and 4 patients (22.2%) had poor outcomes. A time limit of >6 weeks for the duration of medical management tended to be associated with worse outcomes (P=0.018). SMAS often developed in patients with normal BMI or no weight loss. Medical treatment has a high success rate, and children with SMAS should be treated medically for at least 6 weeks before surgical treatment is considered.
Adolescent ; Bile Reflux/diagnosis ; Child ; Child, Preschool ; Demography ; Domperidone/therapeutic use ; Dopamine Antagonists/therapeutic use ; Drug Administration Schedule ; Female ; Histamine H2 Antagonists/therapeutic use ; Humans ; Infant ; Male ; Parenteral Nutrition ; Retrospective Studies ; Superior Mesenteric Artery Syndrome/*diagnosis/drug therapy ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; Weight Loss

Gas within the gastric wall is an alarming finding and a rare condition. Clinically, this condition is divided into two entities; Gastric emphysema and emphysematous gastritis. These two diseases should be differentiated because they are characterized by different clinical symptoms, possible etiology, treatment and prognosis. While emphysematous gastritis is a severe condition with high mortality, gastric emphysema is asymptomatic and usually has benign course. Rarely, anorexia nervosa and bulimia nervosa have been discribed to be associated with acute gastric distension and duodenal obstruction induced by superior mesentery artery syndrome. So, gastric emphysema could be accompanied by acute gastric distension induced by anorexia nervosa. We report a rare case of gastric emphysema in a patient with anorexia nervosa presenting as superior mesenteric artery syndrome with relevant literatures. In this case, the gastric emphysema was improved without surgical intervention after nasogastric tube for decompression and feeding insertion in the fourth portion of the duodenum.
Acute Disease ; Adolescent ; Anorexia Nervosa/complications/*diagnosis ; Emphysema/complications/*diagnosis ; Female ; Gastric Dilatation/complications/*diagnosis/radiography ; Humans ; Intubation, Gastrointestinal ; Superior Mesenteric Artery Syndrome/diagnosis ; Tomography, X-Ray Computed

Superior mesenteric artery (SMA) syndrome is an uncommon cause of duodenal outlet obstruction. Symptoms and signs suggestive of this condition are nonspecific, and a high index of suspicion coupled with appropriate imaging studies are necessary for diagnosis. We present the case of a 70-year-old man who developed SMA syndrome following prolonged hospitalisation for a surgically treated bleeding duodenal ulcer. His SMA syndrome resolved after successful nonoperative management based on accepted guidelines for nutritional therapy, thus avoiding the need for reoperation and its attendant risks in a malnourished patient.
Aged ; Duodenal Obstruction ; drug therapy ; Duodenal Ulcer ; complications ; surgery ; Endoscopy ; Hospitalization ; Humans ; Male ; Malnutrition ; Nutrition Therapy ; methods ; Refeeding Syndrome ; diagnosis ; Superior Mesenteric Artery Syndrome ; diet therapy ; Treatment Outcome

Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by compression of the third segment of the duodenum by the mesenteric artery at the level of the SMA, resulting in duodenal dilatation. Precipitating factors of the SMA syndrome include prolonged bed rest, weight loss, abdominal surgery, and increased lordosis of the spine. We report a case of SMA syndrome caused by anorexia nervosa in a 15-year-old adolescent girl. CT and an upper gastrointestinal contrast series revealed partial obstruction of the third portion of duodenum and decreased aortomesenteric distance. The patient's symptoms were successfully treated with total parental nutrition and psychiatric treatment including supportive, cognitive behavioral therapy and antidepressant medication. This case shows that SMA syndrome is an unusual gastrointestinal complication that may occur in patients with anorexia nervosa.
Adolescent ; Anorexia Nervosa/*complications ; Antidepressive Agents/therapeutic use ; Cognitive Therapy ; Endoscopy, Gastrointestinal ; Female ; Fluoxetine/therapeutic use ; Humans ; Parenteral Nutrition, Total ; Superior Mesenteric Artery Syndrome/*diagnosis/*etiology/therapy ; Tomography, X-Ray Computed

Superior mesenteric artery syndrome (SMAS) is a rare cause of proximal duodenal obstruction resulting from compression of the duodenum by the SMA against the aorta. Risk factors associated with SMAS are prolonged supine position, weight loss and decreased abdominal wall muscle tone; all of which are frequently accompanied with traumatic brain injury (TBI). The following case report describes a patient who developed SMAS in the setting of TBI. This report presents a 16 year old male with TBI who had postprandial epigastric pain, vomiting and weight loss. Computed tomography and upper gastrointestinal series demonstrated the existence of SMAS. The patient was managed conservatively with total parenteral nutrition to obtain a positive nitrogen balance. Physician should consider SMAS in the differential diagnosis of patients presenting with abdominal pain and vomiting.
Abdominal Pain ; Abdominal Wall ; Aorta ; Brain ; Brain Injuries ; Diagnosis, Differential ; Duodenal Obstruction ; Duodenum ; Humans ; Male ; Mesenteric Artery, Superior ; Muscles ; Nitrogen ; Parenteral Nutrition, Total ; Risk Factors ; Superior Mesenteric Artery Syndrome ; Supine Position ; Vomiting ; Weight Loss

Biliary complications after liver transplantation occur in 13~35% of patients. Biliary cast syndrome, cast formation of biliary sludge along the bile duct, can develop in 4~18% of liver transplant recipients, although the incidence rate is significantly decreasing due to the improvement of graft harvesting and preservation. It is very important that early diagnosis and effective management of biliary cast syndrome be performed when there is a bile duct stricture or dilatation associated with jaundice and cholangitis in the recipient after liver transplantation, due to the possibility of retransplantation and death of the patient from graft loss. We report a case of a biliary cast formed with suppurative cholangitis and extracted incidentally with a plastic biliary stent during an endoscopic procedure after cadaveric liver transplantation, in which the ERCP findings revealed a stricture at the anastomosis site of the common bile duct and cholangitis.
Bile ; Bile Ducts ; Cadaver ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis* ; Common Bile Duct ; Constriction, Pathologic* ; Dilatation ; Early Diagnosis ; Humans ; Incidence ; Jaundice ; Liver Transplantation* ; Liver* ; Plastics ; Stents ; Superior Mesenteric Artery Syndrome* ; Transplantation ; Transplants