Marty Zdichavsky, MD, Jessica Lange, MD, Philipp Horvath, MD, Stefan Beckert, MD, Alfred Königsrainer, MD. University Hospital Tübingen, Germany
Aims: We report and discuss our experiences with celiac (CMAS) and superior (SMAS) mesenteric artery syndrome that are both associated with similar gastrointestinal symptoms like chronic abdominal pain resulting in weight loss because of fear of eating.
Methods: Between 2011 and 2016, 9 patients were presented in our institution. 8/9 patients suffered from typical symptoms of chronic or intermediate epigastric pain sometimes associated with deterioration of physical activity. All patients complained weight loss and difficulties of weight regain because of fear of eating and/or pain despite small portions of food intake. 1/9 patient was referred to our emergency department after an attack of abdominal pain and nausea. Computed tomography revealed massive dilatation of the stomach with gastric wall and hepatic portal vein gas as signs of severe ischemic tissue injury. Patient's history revealed chronic abdominal pain since 5 years with post-prandial distress syndrome.
Results: In 7/9 patients CMAS was diagnosed and patients underwent laparoscopic division of the median arcuate ligament after exposion of the celiac trunk. No major complications occurred intra- or post-operatively. One 78-year old patient (ASA-III) needed intensive care treatment because of tachy-hyperpnoe and hypocapnia post-operatively. All patients experienced symptomatic relief. 2/9 patients had diagnosis of SMAS. One patient could regain weight with improvement of pain symptoms under conservative treatment with sufficient pain medication. The other was presented with an acute abdomen. Gastroscopy showed disseminated necrotic alterations of the mucous membrane and additionally compression of the horizontal part of the duodenum. MRI confirmed SMAS. Naso-gastric tube for ten days achieved decompression and toning of the stomach before open surgery. Mobilization of the duodenum, transection of a fixating band of connective tissue between the SMA and aorta and refixation of the duodenum in the retroperitoneum was performed. The stomach was vital and could be preserved. Seven days after surgery the patient could be discharged fully recovered.
Conclusions: Decompression of the celiac trunk in case of CMAS can be performed laparoscopically. SMAS might need acute surgical therapy in case of decompensation of the emptying of the stomach. Conservative treatment can be discussed with the patient when surgical treatment is considered cautiously.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79717
Program Number: P582
Presentation Session: Poster (Non CME)
Presentation Type: Poster