Superior mesenteric artery syndrome

Abstract

A 21-year-old female presented with history of vague abdominal discomfort, vomiting, and weight loss for 6 months. The vomiting had gotten more frequent in the last 2 months, a few hours following almost every meal. She had lost about 8 kg body weight in 6 months. Her body mass index was 17.36 kg/m 2. Following an unremarkable ultrasound of the abdomen and upper gastrointestinal endoscopy, a barium meal was obtained which showed an abrupt cutoff at the third part of duodenum with proximal distention (Figure 1). A contrast-enhanced computerized tomography (CECT) showed an aorto-mesenteric angle (AO) of 20° (Figure 2) and the aorto-mesenteric distance (AO) of 2.9 mm (Figure 3). Superior mesenteric artery (SMA) syndrome was diagnosed. The patient was kept under conservative management. Highcalorie, low-volume diet and prokinetic agents were prescribed via a naso-jejunal tube. She was symptomatically better and was gaining weight. Oral feeding was encouraged, and naso-jejunal tube was removed by the third week. However, she was lost to follow-up after 3 months. Superior mesenteric artery syndrome is considered one of the rare causes of duodenal obstruction. Reduced AO angle (<22-28°) and AO distance (2-8 mm) are highly suggestive. 1

Case Report: Superior mesenteric artery syndrome-induced pancreatitis

“…In fact, a CT scan can calculate the angle between the AMS and the aorta, which is reduced between 7° to 22°, whereas it is normally between 38° and 65°. The aorto-mesenteric distance is also reduced and generally measures between 2-8 mm, while the normal distance is 10 to 28 mm [1]. A diagnosis of SAMS must be deduced with caution since it is generally confirmed after the presence of symptoms of SAMS associated with an aortomesenteric angle <22-25° and an aortomesenteric distance <8 mm [4] .…”

“…Superior mesenteric artery syndrome (SMAS) is a rare condition resulting from vascular compression, in which, the third part of the duodenum is compressed between the aorta and the superior mesenteric artery [1]. In fact, many predisposing factors for SAMS, with a potential impact on the aortomesenteric angle, have been identified.…”

Incomplete small bowel obstruction in a patient with ankylosing spondylitis

“…Besides, unusual body shape is a rare risk factor for small bowel obstruction. In patients with skinny body shape, superior mesenteric artery syndrome should be considered, whose duodenum was compressed between the aorta and the superior mesenteric artery [3] . In our case of ankylosing spondylitis and scoliosis, the patient's duodenum went wrong direction due to torturous body shape and smaller abdominal cavity.…”

Superior mesenteric artery syndrome (Wilkie Syndrome) with unusual clinical onset: Description of a rare case

“…Wilkie's Syndrome (WS) also known as Superior Mesenteric Artery Syndrome [1] is a very rare disease caused by aorto-mesenteric space (AMS) reduction resulting in duodenum compression [2] . It can be congenital or acquired.…”