An unusual presentation of congenital superior mesenteric artery (SMA) syndrome

Trestrail, Timothy; Martin, Emily K.; Bhutiani, Neal; Mortensen, Garrett F; Davidyuk, Vladimir; Vitale, Gary C.

doi:10.1093/jscr/rjz067

Cited by 1 publication

(3 citation statements)

References 6 publications

(8 reference statements)

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“…However, other conditions (i.e., anatomical, surgical, pubescent) may predispose aortomesenteric angle decreases as well. [2][3][4][5][6] Congenital SMAS is very rare, with only a small number of patients being diagnosed in the medical literature. Congenital SMAS occurs due to an abnormal anatomical placement of the ligament of Treitz.…”

Section: Discussionmentioning

confidence: 99%

“…Congenital SMAS occurs due to an abnormal anatomical placement of the ligament of Treitz. 5 The syndrome can also be a postoperative complication in corrective spinal surgery for scoliosis due to the acute vertical traction and stress placed on the spine, leading to abrupt aortomesenteric angle narrowing. 6 Functional SMAS has been described, with one particular case caused by an inferior vena cava (IVC) filter that created a local inflammatory response, compressing the duodenum between the IVC and the superior mesenteric artery.…”

Section: Discussionmentioning

confidence: 99%

“…1 Abnormal gastrointestinal anatomy, corrective spinal surgery, and pediatric growth spurts have all been described causing SMAS as well. [2][3][4][5][6] Conditions causing rapid weight loss (e.g., anorexia nervosa, malabsorption, and cancer) can each decrease the fat pad cushion, leading to SMAS. 2 Common presenting complaints include less specific gastrointestinal obstruction symptoms, such as nausea, vomiting, early satiety (i.e., "feeling full") and postprandial (i.e., after meal) pain.…”

Section: Intoductionmentioning

confidence: 99%

See 2 more Smart Citations

Wilkie’s Weight Loss Wonder: A Case Series

Haidar

Davies

Hussain

et al. 2020

Spartan Medical Research Journal

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INTRODUCTION Wilkie’s Syndrome, also known as Superior Mesenteric Artery Syndrome (SMAS), is a rare cause of bowel obstruction that can contribute to vague abdominal symptoms on clinical presentation. This syndrome occurs when the aortomesenteric angle decreases, compressing the third portion of the duodenum between the aorta and the superior mesenteric artery. An acute decrease in the mesenteric fat pad cushion between these two blood vessels is the primary etiology, although other causes (e.g., anatomical, postoperative, functional, and pubescent etiologies) have also been described. CASE PRESENTATION In the present cases, 2 females with a common history of recent weight loss presented to our institution with similar symptoms of abdominal pain, nausea and vomiting. Each patient was subsequently diagnosed with SMAS following imaging studies. Both patients experienced successful resolution of symptoms with conservative nutritional management. DISCUSSION Common presenting complaints of SMAS include nausea, vomiting, early satiety and postprandial pain. These symptoms overlap with other gastrointestinal disorders (i.e., mesenteric ischemia, intestinal volvulus, peptic ulcer disease) making diagnosis difficult. SMAS can be identified through imaging modalities including barium studies and computer tomography. First line therapies typically include conservative nutritional support and promotion of weight gain. If conservative therapies fail, various surgical procedures can be pursued. Delayed diagnosis can lead to further pathological sequelae, including duodenal compromise, ischemia and necrosis. As the syndrome progresses, success of conservative nutritional support is less likely, and surgical correction becomes increasingly necessary. CONCLUSION Therefore, a clinical goal for SMAS should include as swift a recognition and diagnosis as possible.

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