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Article in press
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Superior Mesenteric Artery and Nutcracker Syndromes in a Healthy 14-Year-Old Girl Requiring Surgical Intervention after Failed Conservative Management
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Abstract [+]
This case report presents the diagnosis of superior mesenteric artery and nutcracker syndromes in a previously fit and well 14-year-old girl. Although these two entities usually occur in isolation, despite their related aetiology, our patient was a rare example of their occurrence together. In this case the duodenal compression of superior mesenteric artery syndrome caused intractable vomiting leading to weight loss, and her nutcracker syndrome caused severe left-sided abdominal pain and microscopic haematuria without renal compromise. Management of the superior mesenteric artery syndrome can be conservative by increasing the weight of the child which leads to improvement of retroperitoneal fat and hence the angle of the artery. The weight can be improved either by enteral feeds or parenteral nutrition. This conservative management initially helped but not in the long-term as the child started losing weight again. The next step in management is surgery (duodenojejunostomy – if the conservative management fails), which the child went through, remarkably improving their symptoms.
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The Importance of Enzyme Substitution Therapy in Early Pancreas Exocrines of Insufficiency
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Introduction
Functional disorders of the digestive tract are a common occurrence in the doctor’s office. In addition to functional dyspepsia, 35% of dyspepsia are unresolved dyspepsia, which are a symptom of the early stage of pancreatic exocrine insufficiency.
Aim
Based on clinical experience, we can suspect and detect chronic pancreatic insufficiency at an early stage, which is the aim of this paper.
Method
To demonstrate the efficacy of enzyme replacement therapy in the early stage of pancreatic exocrine insufficiency using the case report of the patient.
Results
Results confirms significance and effectiveness of creon as an enzyme replacement therapy in the treatment of malabsorption and maldigestion.
Conclusion
Creon (pancreatin) showed great effect in the treatment of dyspepsia and anorexia nervosa, body mass index (BMI) for 30 days increased from 15.9 to 17.4, which leads us to the conclusion that unrecognized chronic pancreatic insufficiency can be expected in long-term dyspepsia.
Keywords
Chronic pancreatic insufficiency; Enzyme; Body mass index (BMI); Digestive tract.
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Associate Editors
Tatiana Goretsky (Zagranichnaya), PhD
Assistant Professor Division of Digestive Diseases and Nutrition Department of Internal Medicine University of Kentucky Lexington, KY 40506, USA
Jacintha O. Sullivan, PhD
Associate Professor Department of Surgery Institute of Molecular Medicine Trinity Centre for Health Sciences St James Hospital Dublin 8, Ireland
Shreyas Saligram, MD, MRCP
Department of of Interventional Gastroenterology Moffitt Cancer Center Department of Gastroenterology Kansas University Medical Center 235 Ward Parkway, Apt 307 Kansas City, MO-64112, USA