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12 April 2018 : Case report  Italy

Superior Mesenteric Artery Syndrome in Patients with Crohn’s Disease: A Description of 2 Cases Studied with a Novel Magnetic Resonance Enterography (MRE) Procedure

Challenging differential diagnosis, Diagnostic / therapeutic accidents, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology

Giuseppe Cicero1ADE*, Tommaso D'Angelo1BE, Antonio Bottari
  • D Data interpretation
  • F Literature analysis/search
" data-author="4322803">2DF
, Giuseppe Costantino
  • B Data collection/entry
  • D Data interpretation
" data-author="4322804">3BD
, Carmela Visalli
  • F Literature analysis/search
" data-author="4322805">2F
, Sergio Racchiusa
  • A Study design/planning
" data-author="4322806">2A
, Maria Adele Marino
  • B Data collection/entry
" data-author="4322807">2B
, Marco Cavallaro1D, Luciano Frosina
  • F Literature analysis/search
" data-author="4322809">2F
, Alfredo Blandino
  • A Study design/planning
  • D Data interpretation
  • E Preparation of manuscript
" data-author="4322810">2ADE
, Silvio Mazziotti
  • A Study design/planning
  • B Data collection/entry
  • E Preparation of manuscript
" data-author="4322811">2ABE

DOI: 10.12659/AJCR.908273

Am J Case Rep 2018; 19:431-437

Abstract

BACKGROUND: Superior mesenteric artery syndrome is caused by vascular compression of the third portion of the duodenum between the aorta and the superior mesenteric artery. It may occur with acute or chronic symptomatology, such as vomiting or postprandial abdominal pain, and it is usually caused by a lack of mesenteric fat pad under conditions of severe weight loss. Crohn’s disease can be one of them.

CASE REPORT: We report 2 cases of Crohn’s disease patients with clinical suspicion of jejunal stricture who underwent MR-enterography with a novel approach. In fact, the examinations were performed including prone position of the patients inside the scanner, drinking of contrast medium during the examination, and prompt acquisition of fluoroscopic sequences. Both the exams showed an abrupt termination of the duodenum on its third portion and a decreased aortomesenteric distance, allowing the diagnosis of superior mesenteric artery syndrome.

CONCLUSIONS: A correlation between Crohn’s disease and superior mesenteric artery syndrome has never before been reported in the literature. The present study provides some practical steps that may be useful in order to improve MRE standard protocol in recognizing this condition while evaluating Crohn’s disease bowel lesions.

Keywords: Crohn Disease, Magnetic Resonance Imaging, Superior Mesenteric Artery Syndrome

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923