title: Superior mesenteric artery syndrome after ileal pouch-anal anastomosis for colon cancer associated with ulcerative colitis: report of a case.
abstract: Superior mesenteric artery syndrome (SMAS) after a surgical operation is very rare. We experienced an extremely rare case of ileal pouch-anal anastomosis with subsequent development of SMAS requiring duodenojejunostomy. A 74-year-old Asian woman underwent total colectomy, ileal pouch-anal anastomosis (J-pouch), covering ileostomy, splenectomy, and distal pancreatectomy for treatment of descending colon cancer associated with ulcerative colitis. She complained of abdominal discomfort and vomiting 17 days postoperatively. Computed tomography (CT) revealed fluid collection at the pancreatic stump. We diagnosed a pancreatic fistula and performed CT-guided drainage. SMAS was thereafter diagnosed by contrast-enhanced CT, which revealed a narrow aortomesenteric angle of 36° and short aortomesenteric distance of 2 mm. The SMAS did not respond to conservative therapy. Finally, we performed duodenojejunostomy. This case illustrates that ileal pouch-anal anastomosis might induce relative stretching of the superior mesenteric artery and flatten it against the aorta, resulting in SMAS.
authors.affiliation: Department of Surgery, Kansai Medical University Takii Hospital, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan. kitadeh@takii.kmu.ac.jp.|Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan. kitadeh@takii.kmu.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kitade
authors.affiliation: Department of Surgery, Kansai Medical University Takii Hospital, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan. matsuurt@takii.kmu.ac.jp.|Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan. matsuurt@takii.kmu.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsuura
authors.affiliation: Department of Surgery, Kansai Medical University Takii Hospital, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan. yanagihi@takii.kmu.ac.jp.|Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan. yanagihi@takii.kmu.ac.jp.
authors.forename: Hidesuke
authors.initials: H
authors.lastname: Yanagida
authors.affiliation: Department of Surgery, Kansai Medical University Takii Hospital, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan. tarokun033@yahoo.com.|Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan. tarokun033@yahoo.com.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Department of Surgery, Kansai Medical University Takii Hospital, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan. nakaik@takii.kmu.ac.jp.|Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan. nakaik@takii.kmu.ac.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Nakai
authors.affiliation: Department of Surgery, Kansai Medical University Takii Hospital, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan. tokuhark@takii.kmu.ac.jp.|Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan. tokuhark@takii.kmu.ac.jp.
authors.forename: Katsuji
authors.initials: K
authors.lastname: Tokuhara
authors.affiliation: Department of Surgery, Kansai Medical University Takii Hospital, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan. hijikawt@takii.kmu.ac.jp.|Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan. hijikawt@takii.kmu.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hijikawa
authors.affiliation: Department of Surgery, Kansai Medical University Takii Hospital, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan. yoshiokk@takii.kmu.ac.jp.|Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan. yoshiokk@takii.kmu.ac.jp.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yoshioka
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan. kon@hirakata.kmu.ac.jp.
authors.forename: A-Hon
authors.initials: AH
authors.lastname: Kwon
keywords: Colorectal cancer; Duodenojejunostomy; Ileal pouch-anal anastomosis; Pancreatic fistula; Superior mesenteric artery syndrome