上腸繫膜動脈症候群手術後腹脹便秘之中醫內科治療病例報告

Chinese herb medical treatment of abdominal distention and constipation after duodenojejunostomy with superior mesenteric artery syndrome - A case report

本病例是一位32歲的女性，患進食後腹脹已十餘年，近兩年脹滿感、泛酸加重，2018年10月經上消化道攝影後診斷為上腸繫膜動脈症候群，經保守治療無效後，於2019年4月12日進行十二指腸空腸吻合手術，術後患者之腹脹曾有短暫改善，然一週後腹脹、便秘復逐漸加重並伴隨嘔吐，經腸胃科檢查顯示腸道吻合端傷口腫脹併腸阻塞，遂入院接受類固醇治療及周邊靜脈營養補充，患者欲合併中醫治療以改善腹脹與便秘。患者經辨證為脾胃虧虛，升舉無力，胃失和降，治療上採用補中益氣湯加減，以補益脾胃，升舉陽氣，和降胃氣等方式用藥。患者之嘔吐、便秘獲得改善，進食後之腹脹感減輕。本病例報告可提供中醫治療上腸繫膜動脈症候群接受手術後仍腹脹、便秘之治療參考。

A 32-year-old woman presented with postprandial abdominal distention for around ten years. The abdominal distention and acid regurgitation got worse in recent two years. She was diagnosed with superior mesenteric artery syndrome after receiving upper GI series in October, 2018. Since conservative therapy was in vain, she received duodenojejunostomy on 12th April, 2019. Her abdominal distention has been temporarily improved after surgery, but one week later, abdominal distention, constipation and vomiting gradually progressed. Image study revealed duodenojejunostomy wound swelling related intestinal obstruction. Therefore, she was admitted for steroid treatment and peripheral parenteral nutrition, and she turned to traditional Chinese medicine treatment for abdominal distention and constipation. The TCM syndrome differentiation for this patient is spleen qi deficiency and failure of stomach qi to descend. The principle of treatment is “invigorating spleen qi for ascending, and regulating stomach for lowering adverse qi”. The patient's vomiting and constipation got improvement, and abdominal distention gradually relieved. This is an effective clinical case to treat abdominal distention and constipation after duodenojejunostomy in patient with superior mesenteric artery syndrome.