Superior mesenteric artery syndrome: Diagnosis and management

Abstract

Superior mesenteric artery (SMA) syndrome (also known as Wilkie's syndrome, cast syndrome, or aorto-mesenteric compass syndrome) is an obstruction of the duodenum caused by extrinsic compression between the SMA and the aorta. The median age of patients is 23 years old (range 0-91 years old) and predominant in females over males with a ratio of 3:2. The symptoms are variable, consisting of postprandial abdominal pain, nausea and vomiting, early satiety, anorexia, and weight loss and can mimic anorexia nervosa or functional dyspepsia. Because recurrent vomiting leads to aspiration pneumonia or respiratory depression via metabolic alkalosis, early diagnosis is required. The useful diagnostic modalities are computed tomography as a standard tool and ultrasonography, which has advantages in safety and capability of real-time assessments of SMA mobility and duodenum passage. The initial treatment is usually conservative, including postural change, gastroduodenal decompression, and nutrient management (success rates: 70%-80%). If conservative therapy fails, surgical treatment ( i.e ., laparoscopic duodenojejunostomy) is recommended (success rates: 80%-100%).

Delayed presentation of Wilkie’s syndrome after scoliotic curve correction surgery: a case report

“…SMA syndrome is diagnosed by a battery of tests starting with a plain abdominal X-ray, barium swallow X-ray, computed tomography (CT), abdominal ultrasound (US), magnetic resonance imaging (MRI), endoscopy and endoscopic ultrasonography (EUS) [ 23 ].…”

“…Most of the cases of SMA syndrome can be managed conservatively in the form of insertion of nasogastric tube, intravenous hydration and correction of electrolyte imbalance – the ‘drip and suck’ approach, along with low volume, high calorie diet [ 17 , 23 ]. Oral intake should be restricted.…”

“…Reduction in this angle can lead to compression of duodenum which can be predisposed by many factors like rapid reduction in body weight, reduced retroperitoneal fat content, or acute spinal lengthening [ 19 , 42 ]. An aortomesenteric angle below 22 degrees and an aortomesenteric distance lesser than 8 mm is the threshold for the radiological diagnosis of SMA syndrome in the appropriate clinical setting [ 23 ]. Scoliosis associated with increased sagittal kyphosis is usually associated with collapse of trunk, and following correction of deformity elongation of trunk becomes more remarkable leading to further narrowing of aorto-mesenteric angle [ 14 ].…”

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

“…The mainstay of management is conservative treatment with decompression using a nasogastric tube, bypassing duodenum with a nasojejunal tube, correction of nutritional deficiencies and electrolyte abnormalities, and total parenteral nutrition or oral nutrition as tolerated. Surgery remains the treatment of choice in refractory cases 1 …”

Chest Pain Redefined: Atypical Presentation of Superior Mesenteric Artery Syndrome

“…Loss of the mesenteric fat pad between the superior mesenteric artery (SMA) and aorta leads to the narrowing of the angle between the vessels, resulting in duodenal compression. Diagnosis is challenging due to non-specific symptoms and low incidence [ 1 ]. We describe a case of SMA syndrome presenting as postprandial chest pain.…”