Superior Mesenteric Artery Syndrome: Past and Present

Nutcracker Syndrome combined with Superior Mesenteric Artery Syndrome in a Pediatric Patient: A Case Report

“…SMA syndrome is a dis ease in which the lumen is compressed by the aortome senteric angle narrowed to the third part of the duodenum and the male to female ratio is 1:1.58-3, which is relatively co mmon in women in their 30-40s 7) . The causes of this disease are largely classified into three categories: 1) weight loss, 2) external or intraperitoneal pressure, and 3) increased mesenteric tension 3) . SMA syndrome commonly occurs in people who are underweight, but other factors are involved in clinical symptoms 8) .…”

“…SMA synd rome can be induced by abdominal casting, external ab dominal compression, or intraperitoneal compression by a tumor or abdominal aortic aneurysm 10,11) . Increased me senteric tension due to structural deformations affecting the aortomesenteric angle caused by surgery is also a risk factor 3) . Clinical symptoms include epigastric pain, con tinuous nausea, and vomiting.…”

“…Doppler USG and contrastenhanced CT showed cha racteristic features of SMA syndrome and nutcracker synd rome. This may be due to the child's unfavorable eating habits and a very skinny body with low body weight (BMI <3 percentile), or to the structural change that affects the angle between the aorta and the superior mesenteric artery after laparoscopic ovarian cystectomy performed three years prior 3) . The patient's vital signs were stable, and there was no serious complication of SMA syndrome such as ga strointestinal perforation, or hematologic findings of nut cracker syndrome accompanying anemia which requires surgical intervention 1) .…”

“…Conservative nonsurgical treatment methods were recommended after consulting with the department of pediatric surgery. In addition, the patient's position was maintained in the left lateral deviation posi tion, prone position, or kneechest posture, resulting in improvement of the intestinal obstruction due to SMA syndrome 3) . On the 2nd day of admission, gross hematuria improved.…”

“…This is caused by a decrease in the aortomesenteric angle, which is the angle between LRV and SMA, due to weight loss, external or intraperi toneal compression, and increased mesenteric tension 2) . If the third part of the duodenum is squeezed due to a reduced aortomesenteric angle, SMA syndrome that causes intestinal obstruction occurs 3) . These two diseases have the same pathogenesis of a decrease in aortomesenteric angle, but the simul taneous occurrence of both diseases is quite rare 4) .…”