Síndrome da Artéria Mesentérica Superior: Relato de Caso

Introduction. Superior Mesenteric Artery Syndrome (SAMS) or Wilkie's syndrome is a rare condition arising from partial or complete obstruction of the third portion of the duodenum by the superior mesenteric artery anteriorly and by the aorta and vertebral column posteriorly. Regarding pathophysiology, a decrease in the aortomesenteric angle of 6-25 degrees (normal value: 38-56 degrees) is observed, as well as a decrease in the distance between these structures up to 2-8 mm (normal value: 10-20mm). Case Report. Female, 21 years old, complains of chronic abdominal pain associated with nausea, vomiting, abdominal distension and weight loss. Contrast-enhanced X-ray shows dilation of the first and second duodenal portion. On computed tomography angiography, the aortomesenteric distance was 7 mm. She underwent a side-to-side duodenojejunoanastomosis. Discussion and Conclusions: The superior mesenteric artery syndrome is a rare entity, with a clinical presentation similar to several other pathologies of the digestive system. This syndrome should be suspected in patients with chronic abdominal pain and symptoms of upper digestive obstruction.Introdução. A Síndrome da Artéria Mesentérica Superior (SAMS) ou síndrome de Wilkie é uma condição rara oriunda da obstrução parcial ou completa da terceira porção do duodeno pela artéria mesentérica superior anteriormente e pela aorta e coluna vertebral posteriormente. Em relação à fisiopatologia observa-se a diminuição do ângulo aortomesentérico de 6-25 graus (valor normal: 38-56 graus) bem como a diminuição da distância entre estas estruturas até 2-8 mm (valor normal: 10-20mm). Relato do Caso. Feminina, 21 anos, queixa-se de dor abdominal crônica associada a náuseas, vômitos, distensão abdominal e perda ponderal. Raio X contrastado evidencia dilatação da primeira e segunda porção duodenal. Na angiotomografia computadorizada a distância aorto-mesentérica era de 7 mm. Foi submetida a duodenojejunoanastomose latero-lateral. Discussão e Conclusões: A síndrome da artéria mesentérica superior é uma entidade rara, com apresentação clínica semelhante à várias outras patologias do aparelho digestivo. Deve-se suspeitar desta síndrome nos pacientes com dor abdominal crônica e sintomas de obstrução digestiva alta

Use of Left Gastric Vein as an Alternative for Portal Flow Reconstruction in Liver Transplantation

Portal vein thrombosis is observed in up to 10% of liver transplant candidates, hindering execution of the procedure. A dilated gastric vein is an alternative to portal vein reconstruction and decompression of splanchnic bed. We present two cases of patients with portal cavernoma and dilated left gastric vein draining splanchnic bed who underwent liver transplantation. The vein was dissected and sectioned near the cardia; the proximal segment was ligated with suture and the distal segment was anastomosed to the donor portal vein. Gastroportal anastomosis is an excellent option for portal reconstruction in the presence of thrombosis or hypoplasia. It allows an adequate splanchnic drainage and direction of hepatotrophic factors to the graft