Superior mesenteric artery syndrome caused by celiac axis compression syndrome: a case report and review of the literature

Abstract

Celiac axis compression syndrome (CACS) is a rare entity of mesenteric ischemia, secondary to inadequate blood supply to the intestine, resulting in weight loss because of postprandial abdominal pain. Superior mesenteric artery (SMA) syndrome is an uncommon cause of intestinal obstruction manifesting with epigastric pain, bilious vomiting, and postprandial discomfort. Although the coexistence of both syndromes is very rare and has been reported only in eight patients in the literature, the CACS as a rare etiology of SMA syndrome has not yet been reported. Herein, we describe an uncommon case of SMA syndrome secondary to the CACS. The 27-year-old woman presented with epigastric pain, postprandial vomiting, and rapid body weight loss. The diagnosis of SMA syndrome was made by hypotonic duodenography and multidetector computer tomographic angiography. The CACS was also suspected by multidetector computer tomographic angiography. Surgical intervention was performed and the presence of CACS was confirmed. Her symptoms subsided shortly after operation and she was in good health at 1-year follow-up.

A comprehensive review of superior mesenteric artery syndrome

“…Reconstructing the structures and calculating the aortomesenteric angle precisely, make it one of the most appropriate techniques. Another impressive fact is that it can demonstrate the direct pressure of the SMA on the entrapped duodenum, which can be very helpful to the surgeon [22,31]. 7) Magnetic resonance angiography: It seems to be equivalent to the 3-D CT angiography and also considered as one of the most valuable methods of diagnosis [1,28].…”

“…aneurysm or neoplasm, etc. The advantage of CT over ultrasonography (USG) is that, it can provide an overall assessment of the abdominal cavity as well as the amount of intra-abdominal and retroperitoneal fat [1,14,19,22,28,33].…”

“…The aortomesenteric angle was measured traditionally by conventional angiography with a lateral aortography; however, this procedure is invasive, expensive, and time-consuming [22]. 6) 3-Dimensional CT angiography: This modality of diagnosis is becoming the most popular as it is rapid, non-invasive and non-expensive.…”

“…The condition is habitually relieved by vomiting, crouching, and postural drainage, when the mesenteric root along with the SMA falls anteriorly away from the aorta, thus relieving the obstruction as in: prone, knee chest and left lateral positions. The compression can also be relieved by applying the Hayes maneuver, where pressure is applied below the umbilicus in a cephalad and dorsal direction thereby, releasing the tension on the small bowel mesentery by elevating it [4,8,22,27].…”

“…a) Severe debilitating illnesses or chronic wasting diseases: causing prolonged best rest and asthenic built like malignancy, cerebral palsy, paraplegia, juvenile rheumatoid arthritis [1], drug abuse [6], secondary to cardiac cachexia [14], AIDS [15,16]; b) Trauma: polytrauma patients in ICU [5,10,12], extensive burn injury [1,10,12], brain and spinal cord injury [12,13,17]; c) Dietary disorders: causing severe weight loss; malabsorption syndrome [12], anorexia nervosa (psychiatric disorder) [13]; d) Postoperative states: bariatric surgery [1,7,18], esophagectomy [7], aortic aneurysm repair, and traumatic mesenteric arteriovenous fistula following abdominal aortic aneurysm repair [4,12], spinal instrumentation, scoliosis with sagittal kyphosis causing severe trunk collapse, in vertebral fractures or external compression by a body cast (hence the name 'Cast Syndrome') [7], proctocolectomy, and ileoanal pouch anastomosis [4,19], Nissen fundoplication [20]; e) Local pathology: neoplastic growth in mesenteric root, dissecting aortic aneurysm [4], traumatic aneurysm of the SMA after a stab wound [12], a flaccid abdominal wall with visceroptosis [8,12], associated with peptic ulcer disease [12], in connective tissue disorders [21], unfrequently associated with coeliac axis compression syndrome [22], compression by a huge mycotic abdominal aortic aneurysm [23]; f ) Other conditions: increased lumbar lordosis as in pregnancy [2], in hyperthyroidism [4], weight loss due to ch...…”