Superior mesenteric artery syndrome

Abstract

Objectives: To determine the prevalence of superior mesenteric artery (SMA) syndrome in patients presenting with abdominal pains, and to evaluate computed tomographic (CT) findings needed for its diagnosis.Methods: This retrospective record-based study was carried out at the radiology department, from January 2016 to January 2021. All young patients (aged under 25) who underwent CT scans for abdominal pains were reviewed. Post-surgery, tumor, and trauma cases were excluded. Imaging findings for SMA syndrome were recorded as 'suggestive' (reduced aortomesenteric angle and distance with proximal duodenal dilatation), 'possible' (reduced angle and distance without proximal duodenal dilatation) and 'probable' (reduction of either angle or distance). Two radiologists interpreted the findings and consensus reporting was made. Diagnoses were confirmed on clinical grounds (symptomatic improvement by specific treatment and exclusion of other diagnoses), or barium studies. Imaging findings were compared to final diagnoses. McNemar's Chi-square test was used to determine association.Results: Out of 141 patients (mean age=10.8, standard deviation=4), 7 (4.9%) patients mostly females were having SMA syndromes based on 'suggestive' imaging criteria (p=0.0005), and one patient underwent surgery. Conclusion:Superior mesenteric artery syndrome is not an uncommon condition and should be considered in differential diagnosis of acute abdomen in young patients after excluding other diagnoses.

An uncommon cause of sub‐acute intestinal obstruction in young adult: Wilkie's syndrome

“…Plain abdominal radiographs reveal findings suggestive of small bowel obstruction whereas barium studies show dilation of the first and second part of the duodenum and a relatively collapsed small bowel distal to the point where the SMA crosses the duodenum. In normal CT findings, the aorto‐mesenteric angle and aorto‐mesenteric distance measure 28–650 and 10–34 mm; in SMA syndrome, both parameters are reduced with values to 60–220 and 2–8 mm 3 . In this case, the aorto‐mesenteric angle was 19.50°, and the aorto‐mesenteric distance was 4.41 mm.…”

“…Medical treatment may be successful in patients with a short history, moderate symptoms and incomplete duodenal obstruction 8 . Surgical management has been proven to be effective in cases with severe symptoms and failure of conservative management with duodenojejunostomy, being the preferred surgical approach 3,9 …”

“…8 Surgical management has been proven to be effective in cases with severe symptoms and failure of conservative management with duodenojejunostomy, being the preferred surgical approach. 3,9 SMA syndrome is thus, a rare disease resulting in lifethreatening outcomes. A high index of suspicion is a must in cases of acute abdomen especially when it is associated with post-prandial pain and weight loss.…”

Diurnal Fasting During Ramadan Leading to Superior Mesenteric Artery Syndrome

“…Gastrojejunostomy is no longer frequently used because of increased postoperative complications, such as blind loop syndrome, and recurrence of symptoms due to nondecompression of the duodenum. [3][4][5][6][7] Postoperatively, patients are followed for resolution of their symptoms, and weight gain is monitored. Contrast studies may be performed after 1-2 weeks to demonstrate patency of the repair and normal duodenal emptying.…”

“…Most patients are managed conservatively, with surgery reserved for refractory cases not responding to conservative treatment. 7…”