思春期早発症の９歳女児に急性発症した上腸間膜動脈症候群の１例

概要

Superior mesenteric artery (SMA) syndrome is an unusual cause of proximal intestinal obstruction. The syndrome is characterized by compression of the third portion of the duodenum due to narrowing of the space between the SMA and aorta and is primarily attributed to loss of intervening mesenteric fat pad. A 9-year-old girl presented with acute vomiting and abdominal pain. The patient was diagnosed with SMA syndrome based on imaging findings, and improved after conservative treatment. In general, risk factors for SMA syndrome in children include congenital anatomic abnormalities, rapid weight loss, severely handicapped children, and scoliosis. At the time of onset, there was no risk factor for SMA syndrome. After 6 months, she had menarche at 9 years and 7 months and was diagnosed with precocious puberty. She had a height spurt from around the age of 8, suggesting that it may have been a risk factor for SMA syndrome. 　　SMA syndrome is also one of the differentials in acute abdomen in children. However, it may not be accompanied by weight loss, and attention should be paid especially if there is an adolescent height spurt. In addition, it is important to keep in mind the complication of precocious puberty when SMA syndrome develops earlier than the standard pubertal age.