Superior Mesenteric Artery Syndrome: The Dark Side of Weight Loss

Sahni, Sakshi; Shiralkar, Malan T.; Mohamed, Safra; Carroll, Robert E.; Jung, Barbara; Gaba, Ron C.; Yazıcı, Cemal

doi:10.7759/cureus.1859

Cited by 15 publications

(18 citation statements)

References 8 publications

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“…These factors can include a shortened or hypertrophic ligament of Treitz, short mesenteric root, low origin of the SMA, adhesions, and Ladd's bands [2]. SMA syndrome can also be acquired post-operatively, with scoliosis surgery reported most commonly [7][8][9][10]. In this patient, restrictive eating patterns consistent with anorexia nervosa and methamphetamine use was the cause of her rapid weight loss, and thus her case of SMA syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Of the factors that can predispose an individual to SMA syndrome, major weight loss appears most frequently, especially if the BMI is below the third percentile [7][8][9]. Reported conditions that can lead to major weight loss, and thus SMA syndrome, include chronic cachectic conditions such as HIV, trauma, anorexia nervosa, and bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

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Superior Mesenteric Artery Syndrome Secondary to Anorexia Nervosa and Methamphetamine Use

Johnson¹,

Paladugu²

2019

Cureus

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Superior mesenteric artery (SMA) syndrome, or Wilkie syndrome, is a rare cause of small bowel obstruction due to compression of the duodenum between the SMA and aorta. Patients most at risk of SMA syndrome include those with rapid weight loss due to a variety of conditions including chronic illness, malignancy, trauma, HIV, eating disorders, substance abuse, or bariatric surgery. Characteristic radiologic findings include an aortomesenteric angle less than 25 degrees and an aortomesenteric distance of less than 8 mm. Symptoms are typically postprandial and notably include abdominal fullness, voluminous emesis, and abdominal pain. Here we present a case of SMA syndrome in a 19-year-old cachectic female who initially presented with sudden-onset nausea, vomiting, and severe abdominal pain. Imaging revealed a severely distend stomach and proximal duodenum with a transition point in the third portion of the duodenum consistent with SMA syndrome. Her symptoms resolved with nasogastric decompression in addition to fluid and electrolyte management. She later endorsed restrictive eating patterns consistent with anorexia nervosa as well as methamphetamine use for weight loss. She underwent close outpatient follow-up for her anorexia nervosa and substance abuse.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Superior Mesenteric Artery Syndrome Secondary to Anorexia Nervosa and Methamphetamine Use

Johnson¹,

Paladugu²

2019

Cureus

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“…Earlier researchers were unable to report an association between BMI and aortomesenteric angle and distance in a cohort of patients with any abdominal pathology [ 16 - 18 ]. Our study suggests that when BMI of a patient decreases, there is a corresponding reduction in SMA angle and distance, which is the novelty of our study.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Superior Mesenteric Artery Syndrome: Evidence from a Case-Control Study

Alzerwi¹

2020

Cureus

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Superior mesenteric artery (SMA) or Wilkie's syndrome is a rare condition arising due to compression of the third part of the duodenum between the abdominal aorta and the superior mesenteric artery. It is important to explore factors which help in suspicion and early diagnosis of the condition. The aim of this study was to find out if measurements of aortomesenteric angle and distance can predict the occurrence of SMA syndrome. Another objective was to find out if the BMI was correlated with the aortomesenteric angle and distance of the patients. Methods A retrospective hospital-based case-control study was conducted in Qimat Rai Gupta Central hospital, Haryana, India from 2018-2020. Out of total 2100 records of acute and chronic abdominal pain patients, only seven cases of Wilkie's syndrome were confirmed via Contrast-Enhanced Computed Tomography (CECT). Information on age, gender, BMI, duration of symptoms, clinical presentation, aortomesenteric angle, and distance was compared among three groups: Group I-SMA syndrome patients (N=7), Group II-acute abdominal pain patients (N=14) and Group III-chronic abdominal pain patients (N=14). Results The hospital prevalence of Wilkie's was found to be 0.3%. The median age of patients in Group I corresponded to 26 years as opposed to Group II (31.5years) and Group III (30.5 years). There was a statistically significant reduction in the aortomesenteric angle and distance of Group I patients (22º, 6mm) as compared to both Group II (52.5º, 11mm) and Group III patients (52º, 11mm). A moderate correlation of BMI was found with aortomesenteric angle (r=0.479) and distance (r=0.357). Conclusions There was a significant reduction in the aortomesenteric angle and distance of the SMA patients as compared to both patients having acute and chronic abdominal pain. The BMI of patients was positively correlated to aortomesenteric angle and distance to the moderate level. Thus BMI along with aortomesenteric angle and distance can predict the presence of SMA syndrome.

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“…Superior mesenteric artery syndrome is an uncommon phenomenon with an estimated incidence in the general population between 0.013% and 0.3% [ 1 , 2 , 3 ]. SMA syndrome is defined as the compression of the third portion of the duodenum between the aorta and the SMA, leading to a functional point of obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…The SMA arises from the abdominal aorta at the first lumbar vertebral body level, and typically maintains an angle of 38 to 65 degrees relative to the aorta, with an aortomesenteric distance of 10 to 28 mm, between which the duodenum traverses [ 4 ]. The root cause of SMA syndrome is narrowing of this distance, causing compression of the duodenum [ 2 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

Post-Operative Superior Mesenteric Artery Syndrome Following Retroperitoneal Sarcoma Resection

Wong

Sutton

Spurrier

et al. 2020

Clinics and Practice

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Superior mesenteric artery (SMA) syndrome is an uncommon phenomenon caused by the compression of the third portion of the duodenum between the aorta and the SMA. Here, we present a previously healthy 15-year-old male who presented with early satiety and 20 kg weight loss. Computed tomography (CT) demonstrated a massive retroperitoneal liposarcoma displacing the entire small intestine into the right upper quadrant. Following resection of the large mass, the patient was intolerant of oral intake despite evidence of bowel function. Abdominal CT revealed a narrowing of the duodenum at the location of the SMA. A nasojejunal feeding tube was placed past this area, and enteral nutrition was initiated before slowly resuming oral intake. Post-operative SMA syndrome is an uncommon complication but should be considered in patients intolerant of oral intake following resection of large abdominal tumors associated with extensive retroperitoneal fat loss, even in the absence of concomitant major visceral resection.

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Superior Mesenteric Artery Syndrome: The Dark Side of Weight Loss

Cited by 15 publications

References 8 publications

Superior Mesenteric Artery Syndrome Secondary to Anorexia Nervosa and Methamphetamine Use

Superior Mesenteric Artery Syndrome Secondary to Anorexia Nervosa and Methamphetamine Use

Predictors of Superior Mesenteric Artery Syndrome: Evidence from a Case-Control Study

Post-Operative Superior Mesenteric Artery Syndrome Following Retroperitoneal Sarcoma Resection

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