Recalling Superior Mesenteric Artery Syndrome

Abstract

Background: Superior mesenteric artery syndrome is uncommon and characterized by postprandial epigastric pain, nausea, vomiting, anorexia and weight loss. The syndrome is caused by compression of the third part of the duodenum in the angle between the aorta and the superior mesenteric artery. This review updates etiology, epidemiology, diagnosis, treatment and outcome of the superior mesenteric artery syndrome. Methods: Review of the literature. Results: Frequently, predisposing medical conditions associated with catabolic states or rapid weight loss result in a decrease of the aortomesenteric angle and subsequent duodenal obstruction. External cast compression, anatomic variants and surgical alteration of the anatomy following spine surgery or ileoanal pouch anastomosis can also precipitate the syndrome. Once radiologic studies have established diagnosis, first-line treatment is usually conservative with jejunal or parenteral nutrition for restoration of the aortomesenteric fatty tissue. If conservative management fails, surgical options include open or laparoscopic duodenojejunostomy or duodenal mobilization and division of the ligament of Treitz. Conclusion: Superior mesenteric artery syndrome is clearly defined and frequently associated with a wide range of predisposing conditions and surgical procedures; clinicians have to consider this syndrome in such a setting. Larger studies are needed to better define the optimal treatment for this disease.

Superior mesenteric artery syndrome due to duodenal edema in a chronic renal failure patient: a case report

“…Duodenal obstruction causes nausea, vomiting, and abdominal distention. The main cause of this syndrome is a narrow aortomesenteric angle and numerous predisposing conditions with a potential impact on the aortomesenteric angle have been summarized into three categories: severe weight loss in catabolic states, external and intra-abdominal compression, or mesenteric tension [2].…”

“…Abdominal X-ray shows the double-bubble sign due to obstruction of the third portion of the duodenum and, also, dilatation of the upper digestive tract from the stomach to the third portion of the duodenum [6]. Furthermore, abdominal CT scan is the most effective imaging technique for assessing the aortomesenteric angle and distance, fat tissue, and obstruction of the duodenum [2]. The normal range of the aortomesenteric angle and distance has been reported to be 38-65°and 10-28 mm, respectively [7,8].…”

“…These treatments include drainage with nasogastric tube placement and mobilization into the prone or left lateral decubitus position, parenteral nutrition to correct the fluid and electrolyte imbalance, and surgical treatment [2]. In this case, nasogastric tube placement for gastrointestinal decompression was performed, and parenteral nutrition was initiated.…”

“…Various causes of SMA syndrome were recently described in detail [2], and the aortomesenteric angle and distance were thought to be the most important factors in the development of SMA syndrome [3]. There are only a few reports on the relationship between dialysis and SMA syndrome in chronic renal failure (CRF) patients [4,5].…”

Radiological Findings of Superior Mesenteric Artery Syndrome

“…Bu sendrom, sıklıkla adölesan ve genç erişkinlerde gö-rülmektedir. [7][8][9] Bu çalışmada SMAS 10-30 yaş aralığında taranmış olup, SMAS sıklığını %1,12 olarak saptadık. Sıklığı literatürden farklı saptamamızın nedeni, üst GIS şikâyeti ile gelen olgularda ve belli bir yaş aralığında inceleme yapmamızdır.…”