Predictors of Superior Mesenteric Artery Syndrome: Evidence from a Case-Control Study

Alzerwi, Nasser A. N.

doi:10.7759/cureus.9715

Cited by 5 publications

(11 citation statements)

References 14 publications

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“…A normal aortomesenteric angle is between 25° and 87° with different subintervals in different reports[ 1 - 4 , 8 , 10 , 13 , 17 ]. The normal reported distance between the two vessels is 10 mm-34 mm[ 2 , 3 , 8 , 21 ], confirmed by imaging studies[ 8 ]. The mean reported angle measurements are 12°[ 13 ] and 13.5°[ 8 ], with a mean measured distance of 4.4 mm[ 8 ].…”

Section: Discussionmentioning

confidence: 82%

“…The most frequently reported symptoms are abdominal pain (92%), nausea, vomiting (77%), and weight loss (69.2%)[ 1 , 4 , 13 , 20 , 21 ], while in some cases, a predominance of vomiting (70%), nausea (66.3%), abdominal pain (65%), anorexia (33.8%), postprandial fullness (33.8%), and early satiety (12.5%) was reported[ 3 , 22 ]. Another reported characteristic is epigastric pain, which worsens in the supine position[ 1 , 4 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…The mean reported angle measurements are 12°[ 13 ] and 13.5°[ 8 ], with a mean measured distance of 4.4 mm[ 8 ]. However, there are variations regarding the angle dimensions, between 6°-22° in different reports[ 1 , 3 , 4 , 8 , 10 , 13 , 21 ], while reported variations regarding distance are between 2 mm and < 10 mm[ 1 - 4 , 8 , 10 , 13 , 21 ]. It has been suggested that the distance is more accurate for SMA diagnosis than the angle[ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Alzervi found a significant reduction in the aortomesenteric angle and distance in patients with SMA syndrome compared to other patients with acute or chronic abdominal pain, while BMI was positively correlated with the aortomesenteric angle and distance. Thus, BMI could be used as a screening factor for SMA syndrome[ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rotational CT from the supine to prone position can demonstrate improved outflow passing the SMA[ 12 ]. Additionally, CT has replaced magnetic resonance enterography (MRE) as a standard investigation[ 1 , 21 ]. The advantage of showing anatomical variants and consequences, such as delayed transit and obstruction, is highlighted in limited reports using MRE[ 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

Apostu¹,

Chira²,

Colcear³

et al. 2022

WJCC

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BACKGROUND Superior mesenteric artery syndrome is a disease with a complex diagnosis, and it is associated with complications that make it even harder to identify. Currently, a frequent association with psychiatric disorders has been noted. Despite numerous case reports and case series, the variability of the disease has not allowed the development of protocols regarding diagnosis and management. CASE SUMMARY A 33-year-old woman presented with abdominal pain, nausea, and bile vomiting over the last 15 mo, associated with a 15-kg weight loss over the last three months. After the onset of the symptoms, the patient was diagnosed with anxiety-depressive disorder and treated appropriately. Standard examinations excluded an organic cause, and the cause of the symptoms was considered psychogenic. The persistence of symptoms, even under treatment, prompted a computer tomography angiography examination of the abdomen and pelvis. The examination identified emergence at a sharp angle of 13.7° of the superior mesenteric artery, with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm. A diagnosis of aortomesenteric clamp was established. Surgical treatment by laparoscopic duodenojejunostomy was performed. Postoperative evolution was marked by a patent anastomosis at 1 mo, with a 10-kg weight gain and improvement of the associated anxiety. CONCLUSION This case report underlines two major aspects. One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders, with an excellent outcome when proper treatment is administered. The second aspect underlines the key role of a multidisciplinary approach and follow-up.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

Apostu¹,

Chira²,

Colcear³

et al. 2022

WJCC

View full text Add to dashboard Cite

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Evaluating aortomesenteric parameters in a tertiary center of Nepal for superior mesenteric artery syndrome diagnosis and risk factors: cross-sectional study

Sapkota,

Adhikari,

Shrestha

et al. 2024

Annals of Medicine &Amp; Surgery

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Background and Objectives: This study examines aortomesenteric angle (AMA) and distance (AMD), critical in superior mesenteric artery (SMA) syndrome. Addressing the scarcity of SMA cases, the research explores potential links with lower body mass index (BMI) and aims to establish normative data for diagnostic and predictive purposes, using contrast-enhanced computed tomography (CT) scans across various BMI and sex categories. Methodology: A retrospective quantitative cross-sectional study was conducted on 189 patients undergoing abdominal contrast-enhanced CT scans between December 2019 and December 2020. Ethical clearance was obtained, and participants provided informed consent. Exclusion criteria targeted specific medical histories. Patient demographics, BMI categories, and imaging data were recorded. Helical 128-slice CT scans were employed, with sagittal-oblique multiplanar reconstructions for parameter assessments. Statistical analysis utilized SPSS 26.0, including Pearson correlation coefficients and mean calculations. Results: The study reveals a mean AMA of 54.07°±8.53° and a mean distance of 16.25±3.44 mm. Elevated BMI is found to positively correlate with AMA and distance, indicating that higher BMI values may augment these parameters, with an additional positive correlation observed between AMA and distance. No significant correlations are found with patient age or gender. Conclusion: The study concludes that decreased BMI may pose a potential risk for SMA syndrome, as evidenced by the observed correlations with aortomesenteric parameters. Understanding these normal values in the Nepalese population is critical for accurate diagnoses and predictions using CT scans. The research highlights the impact of demographic factors on these parameters and emphasizes their significance in clinical assessments related to SMA syndrome.

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Massive Gastric Dilatation and Multi-Organ Ischemia Due to Superior Mesenteric Artery Syndrome: A Rare Case Report

2023

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Patient: Male, 83-year-old Final Diagnosis: Superior mesenteric artery syndrome Symptoms: Shock Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Unusual clinical course Background: Superior mesenteric artery (SMA) syndrome, a rare condition in which the SMA and aorta occlude the third duodenal portion, can cause serious complications. We present the case of an 83-year-old Japanese man who presented with shock because of massive gastric dilatation due to SMA syndrome and developed multi-organ ischemia. Case Report: The day before admission, the patient had visited the emergency department with abdominal pain and was sent home following spontaneous symptom resolution, but experienced abdominal pain flare-up. His history included diabetes mellitus, hypertension, gastric ulcer, prostatic hypertrophy, esophageal hiatal hernia, and esophageal cancer. Plain computed tomography showed gastric dilatation and obstruction of the duodenal third portion by the SMA, leading to SMA syndrome diagnosis. Since a nasogastric tube could not be manually inserted into the stomach and the gastric dilatation could not be decompressed, the tube was inserted endoscopically. Endoscopy revealed mechanical obstruction of the gastric cardia and gastric mucosal ischemia. He was admitted to intensive care, and blood pressure was maintained with vasopressors and blood transfusion. The next day, contrast-enhanced computed tomography performed for persistently elevated lactate levels revealed extensive ischemia affecting multiple gastrointestinal organs. Surgery and other treatments were considered too risky due to the patient’s advanced age and condition. Best supportive care was administered after discussion with the family, and he died on the second day of hospitalization. Conclusions: SMA syndrome with extensive ischemia and infarction is rare. Given this, clinicians should remain vigilant for its potential complications.

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Predictors of Superior Mesenteric Artery Syndrome: Evidence from a Case-Control Study

Cited by 5 publications

References 14 publications

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

Evaluating aortomesenteric parameters in a tertiary center of Nepal for superior mesenteric artery syndrome diagnosis and risk factors: cross-sectional study

Massive Gastric Dilatation and Multi-Organ Ischemia Due to Superior Mesenteric Artery Syndrome: A Rare Case Report

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