The Superior Mesenteric Artery Syndrome The Disease That Isn??t, Or Is It?

Cohen, Lawrence B.; Field, Steven; Sachar, David B.

doi:10.1097/00004836-198504000-00002

Cited by 97 publications

(64 citation statements)

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“…SMA syndrome (also known as Wilkie's syndrome) [4] is commonly due to reduced aortomesenteric angle and distance between the vessels causing compression of the third part of the duodenum [5]. Other causes include duodenal malrotation due to peritoneal adhesions causing duodenal compression, anomalous low origin of SMA, and high insertion of the duodenum by the ligament of Treitz [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Measurement of the Distance and Angle Between the Aorta and Superior Mesenteric Artery on CT Scan: Values in Indian Population in Different BMI Categories

et al. 2013

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The primary intention of the study was to "prove" that the reduced angle and distance between the superior mesenteric artery (SMA) and aorta significantly correlates with reduced body mass index (BMI). This in turn indicates the strong etiological role of this factor for causation of SMA syndrome. (Most literature till date still mentions sudden depletion of fat pad between the vessels as a "proposed predisposing factor"). The superior mesenteric artery syndrome is characterized by the compression of the third segment of the duodenum by the mesentery at superior mesenteric artery level and a resulting duodenal (±gastric) dilatation. The disease is closely related with the depletion of the fat pad between the vessels narrowing the angle and reducing the distance between the vessels. A prospective study of 100 patients (58 males and 42 females) in the age range 15-85 years (mean age 50 years) who had undergone CT scan for various other complaints. CT scan had been performed with routine protocol comprising plain phase followed by arterial and venous phase by measuring the angle between the aorta and superior mesenteric artery, and also BMI was calculated. Mean values for distance and angle were obtained with standard deviation and 95 % confidence intervals. Pearson coefficients were also calculated and results tabulated. A strong positive correlation exists between BMI and the angle between the aorta and SMA. With increment in BMI, the angle also increases so less chance of developing superior mesenteric artery syndrome.

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Section: Discussionmentioning

confidence: 99%

Measurement of the Distance and Angle Between the Aorta and Superior Mesenteric Artery on CT Scan: Values in Indian Population in Different BMI Categories

et al. 2013

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“…Many other causes have also been implicated including high insertion of the duodenum at the ligament of Treitz, a congenitally low origin of the SMA, a short ligament of Treitz, and compression of the third part of duodenum by peritoneal adhesion as in this reported case [2,8].…”

Section: Discussionmentioning

confidence: 98%

Wilkie’s syndrome: an uncommon cause of intestinal obstruction

Bhattacharjee

2008

Indian J Surg

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A 10-year-old boy presented with 9 months history of gradually worsening, recurrent postprandial upper abdominal pain, bilious vomiting and loss of weight. On examination the child was undernourished, had epigastric fullness and succusion splash was positive. Ultrasonography of the abdomen suggested a massively distended stomach, while an upper gastrointestinal contrast study showed a hugely dilated stomach along with dilated fi rst and second parts of the duodenum with abrupt cut off at the level of third part of duodenum. Contrast enhanced CT scan of the abdomen revealed dilatation of the second part of the duodenum without any obvious abnormality of the aorta-superior mesenteric artery angle. Upper gastrointestinal endoscopy showed retained fl uid and food material within a dilated stomach and second part of the duodenum; scope could not be negotiated into the third part because of an extrinsic compression. The child was diagnosed to be suffering from Wilkie's syndrome. Exploratory laparotomy, performed when conservative management failed, revealed compression of the third part of duodenum by a shortened ligament of Trietz and dense peritoneal bands near the third part of duodenum. The duodenal obstruction was bypassed by performing duodenojejunostomy. The child had an uneventful postoperative recovery. He gained around 6.8 kilograms within next fi ve months.Keywords High intestinal obstruction . Superior mesenteric artery (SMA) syndrome . duodenojejunostomy. Key messageWilkie's syndrome is a rare cause of upper GI obstruction in children and young adults and should be considered when other common causes have been excluded. Surgical intervention, in the event of failure of conservative treatment, gives gratifying results.

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“…1 Usually the angle of aorta mesenteric is 25° to 60 and the distance between the two is 10 to 28mm. In SMA syndrome, these two values are reduced, and varies from 6° to wards 15° and 2 up to 8mm 2 .…”

Section: Discussionmentioning

confidence: 99%