宮田 哲¹, 松村 到¹, 大木 篤¹, 柴本 茂樹¹, 作山 欽治¹, 柏原 赳¹, 川上 房男¹, 多胡 基¹, 奥野 巍一¹, 中村 健治², 山田 克己³

Satoshi MIYATA¹, Itaru MATSUMURA¹, Atsushi OHKI¹, Shigeki SHIBAMOTO¹, Kinji SAKUYAMA¹, Takeshi KASHIHARA¹, Fusao KAWAKAMI¹, Hajime TAKO¹, Giichi OKUNO¹, Kenji NAKAMURA², Katsumi YAMADA³

¹市立伊丹病院内科, ²市立伊丹病院放射線科, ³市立伊丹病院外科

¹Department of Internal Medicine, Itami City Hospital, ²Department of Radiology, Itami City Hospital, ³Department of Surgery, Itami City Hospital

キーワード : SMA syndrome, Bezoar, Duodenal ileus

A 27-year-old woman, who had recurring episodes of vomiting for ten years, was admitted complaining postprandial vomiting, abdominal pain, systemic cramp and drowsiness. The pain was relieved by lying in the prone position. The diagnosis of superior mesenteric artery (SMA) syndrome with bezoar was confirmed by radiological and ultrasonic examination revealing dilatation of the stomach and proximal duodenum, abrupt obstruction of the third portion of the duodenum and the existence of bezoar. A duodenojejunestomy and extraction of the bezoar were performed after conservative treatment. She is doing well after surgical treatment. Important factors in worsening mechanical compression of the duodenum by the SMA are a narrow angle of takeoff of the SMA as it arises from the aorta, and a close distance between the aorta and the SMA. Ultrasonic examination is useful for discerning these anatomical relation between the SMA and the aorta, especially in an emergent case. Thus we suggest that ultrasonic examination can be the first chosen method in diagnosing the SMA syndrome. Moreover, we could detect an accompanied bezoar by ultrasonic examination in this case.