每日一题_2023.07.20

A 26-year-old man from Somalia presented with a 5-month history of dry cough, night sweats, and unintentional weight loss of 18 kg. During this period, epigastric pain and postprandial vomiting had also developed. His BMI was 11. On examination, he was cachectic with abdominal distention and diffuse tenderness to palpation. On the basis of chest imaging and sputum studies, a diagnosis of pulmonary tuberculosis was made, and intravenous antituberculous treatment was initiated. However, he continued to have postprandial vomiting. Contrast-enhanced CT of the abdomen was obtained. What is the cause of his abdominal symptoms?

一名来自索马里的26岁男性因5个月的干咳、盗汗和意外体重减轻18 kg就诊。在此期间，还出现了上腹痛和餐后呕吐。他的BMI为11。检查时，患者有恶病质、腹胀和弥漫性触痛。根据胸部影像学和痰检查，患者被诊断为肺结核，并开始静脉内抗结核治疗。然而，他继续有餐后呕吐。行腹部增强CT检查。他腹部症状的原因是什么?

A. Chronic mesenteric ischemia 慢性肠系膜缺血

B. Gastric tuberculosis 胃结核

C. Gastrointestinal lymphoma 胃肠道淋巴瘤

D. Intussusception 肠套叠

E. Superior mesenteric artery syndrome 肠系膜上动脉综合征

答案解析：

正确答案是肠系膜上动脉综合征。腹部CT示肠系膜及皮下脂肪缺乏，胃扩张，肠系膜上动脉与主动脉间十二指肠受压，主-肠系膜距离为3 mm(参考范围10 ~ 20 mm)，主-肠系膜夹角为7°(参考范围45 ~ 60°)。诊断为结核恶病质引起的肠系膜上动脉综合征。

正确答案：E