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PICTURES IN CLINICAL MEDICINE
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Superior Mesenteric Artery Syndrome Presented with Parkinson’s Disease Hirofumi Goto 1, Hiroharu Kawakubo 2,3, Koichi Miyahara 2,4 and Hiroaki Kawasoe 2 Key words: Parkinson’s disease, superior mesenteric artery syndrome, weight loss
(Intern Med 55: 2319, 2016) (DOI: 10.2169/internalmedicine.55.6795)
Picture.
A 79-year-old man was treated for Parkinson’s disease (PD) (Hoehn and Yahr IV) with L-dopa for seven years and chronic constipation with laxatives and lost 6.8 kg within two years. He complained of postprandial abdominal fullness and abdominal pain for several days. Enhanced abdominal computed tomography showed gastric dilatation with narrowing of the third part of the duodenum (arrowhead) between the superior mesenteric artery (arrow) and the aorta (Picture). A diagnosis of superior mesenteric artery syndrome (SMAS) was thus confirmed. Nasogastric tube placement for gastric decompression was effective at the onset and after recurrence; however, the patient died of systemic circulation failure due to acute gastric dilatation after the second recurrence. Chronic wasting disease with mesen-
teric and retroperitoneal fat depletion potentially causes SMAS (1). Clinicians should therfore recognize that PD is a predisposing condition for SMAS because weight loss with a reduction in body fat is common in PD patients (2). The authors state that they have no Conflict of Interest (COI).
References
１
1. Welsch T, Büchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg 24: 149-156, 2007. 2. Lorefält B, Toss G, Granérus AK. Weight loss, body fat mass, and leptin in Parkinson’s disease. Move Disord 24: 885-890, 2009.
Deparment of Neurology, Imari Arita Kyoritsu Hospital, Japan, ２ Deparment of Internal Medicine, Imari Arita Kyoritsu Hospital, Japan, ３ Deparment of Internal Medicine, Saga Medical School, Japan and ４ Deparment of Internal Medicine, Karatsu Red Cross Hospital, Japan Received for publication November 5, 2015; Accepted for publication December 2, 2015 Correspondence to Dr. Hirofumi Goto, [email protected] Ⓒ 2016 The Japanese Society of Internal Medicine Journal Website: http://www.naika.or.jp/imonline/index.html
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PICTURES IN CLINICAL MEDICINE
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Superior Mesenteric Artery Syndrome Presented with Parkinson’s Disease Hirofumi Goto 1, Hiroharu Kawakubo 2,3, Koichi Miyahara 2,4 and Hiroaki Kawasoe 2 Key words: Parkinson’s disease, superior mesenteric artery syndrome, weight loss
(Intern Med 55: 2319, 2016) (DOI: 10.2169/internalmedicine.55.6795)
Picture.
A 79-year-old man was treated for Parkinson’s disease (PD) (Hoehn and Yahr IV) with L-dopa for seven years and chronic constipation with laxatives and lost 6.8 kg within two years. He complained of postprandial abdominal fullness and abdominal pain for several days. Enhanced abdominal computed tomography showed gastric dilatation with narrowing of the third part of the duodenum (arrowhead) between the superior mesenteric artery (arrow) and the aorta (Picture). A diagnosis of superior mesenteric artery syndrome (SMAS) was thus confirmed. Nasogastric tube placement for gastric decompression was effective at the onset and after recurrence; however, the patient died of systemic circulation failure due to acute gastric dilatation after the second recurrence. Chronic wasting disease with mesen-
teric and retroperitoneal fat depletion potentially causes SMAS (1). Clinicians should therfore recognize that PD is a predisposing condition for SMAS because weight loss with a reduction in body fat is common in PD patients (2). The authors state that they have no Conflict of Interest (COI).
References
１
1. Welsch T, Büchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg 24: 149-156, 2007. 2. Lorefält B, Toss G, Granérus AK. Weight loss, body fat mass, and leptin in Parkinson’s disease. Move Disord 24: 885-890, 2009.
Deparment of Neurology, Imari Arita Kyoritsu Hospital, Japan, ２ Deparment of Internal Medicine, Imari Arita Kyoritsu Hospital, Japan, ３ Deparment of Internal Medicine, Saga Medical School, Japan and ４ Deparment of Internal Medicine, Karatsu Red Cross Hospital, Japan Received for publication November 5, 2015; Accepted for publication December 2, 2015 Correspondence to Dr. Hirofumi Goto, [email protected] Ⓒ 2016 The Japanese Society of Internal Medicine Journal Website: http://www.naika.or.jp/imonline/index.html
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