A Case of Superior Mesenteric Artery Syndrome Presenting with Portal Venous Gas

Takehiro Sakai, Nobuo Yagihashi, Tadaharu Osawa and Osamu Harada

The Department of Surgery, Kuroishi City Hospital

A 81-year-old man with cerebral infarction admitted for persistent vomiting and marked abdominal distension was found in abdominal X-ray to have marked gastric dilation, and enhanced CT showed portal venous gas and marked dilation of the duodenum proximal to the superior mesenteric artery with collapsed distal intestine, confirming the diagnosis of superior mesenteric artery syndrome presenting with acute gastric dilation and portal venous gas. The patient was treated conservatively with nasogastric suction and total parenteral nutrition. Although, he suffered from aspiration pneumonia, he responded rapidly to treatment. On hospital day 5, gastric dilation and portal venous gas had improved and the aortomesenteric angle was reduced in CT examination. On hospital day 6, an upper gastrointestinal series revealed gastric emptying and a narrowed segment at the third portion of the duodenum with proximal distension. Because of dysphagia and dysmasesis, the patient underwent enteral feeding via nasojejunal tube extending beyond the site of obstruction and into the proximal jejunum on hospital day 12, and was discharged on hospital day 19. Superior mesenteric artery syndrome with acute portal venous gas may thus be improved by conservative treatment.

Key words
superior mesenteric artery syndrome, portal venous, gastric dilation

Reprint requests
Takehiro Sakai Department of Surgery, Kuroishi City Hospital
1-70 Kitami-cho, Kuroishi, 036-0541 JAPAN

Accepted
November 30, 2004

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