Unusual Etiologies for Vascular Duodenal Compression Mimicking the Superior Mesenteric Artery (SMA) Syndrome: The SMA-Like Syndrome

Dross, Peter; Molavi, Shawdon; Chan, Alex; Latshaw, Rachael; Chhabra, Pankaj

doi:10.1055/s-0039-1694833

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…The above radiological signs are evidence of peptic pathology, i.e., hypersecretion of hydrochloric acid. Caterine et al [23], as well as Dross et al [24], believe that a diagnosis of SMAS is not supported by impression found to the right of the vertebral bodies. They suggest calling such cases "superior mesentery artery-like syndrome," which is supposedly caused by compression by other vessels.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, the length of the narrowing in the intestine to the right of the spine is on average 3.30 ± 0.15 cm, which cannot be caused by any vessel. Thirdly, if the clinic appears over the age of 80 [24], then it is obvious that other reasons caused these symptoms. On the other hand, the claim that the presence of a narrowing in the center of L-3 or to the left of it is evidence of SMAS is not supported by research.…”

Section: Discussionmentioning

confidence: 99%

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Superior Mesenteric Artery Syndrome Results From Hypersecretion of Hydrochloric Acid

Levin

2024

Preprint

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It is currently believed that the cause of superior mesenteric artery syndrome (SMAS) is compression of the duodenum in the angle between the aorta and superior mesenteric artery (SMA). It is recognized that a decrease in aortomesenteric angle (AMA) <25° and intervascular distance < 8 mm, caused by fat loss, is characteristic of SMAS. Based on these statements, surgeons operate on patients with symptoms of dyspepsia only based on a reduction of AMA. This study is devoted to the analysis of the literature, including four own studies on this issue. Results: Measurement of the length of the constriction in the third part of the duodenum on radiograms from available sources showed that its true length ranged from 2.5 to 4.2 (3.30±0.15) cm and began a few centimeters cranial to the AMA. Therefore, it could not have been caused by compression in the AMA. In terms of length (3.20±0.15 cm) and location, this constriction corresponded to Ochsner’s sphincter, which normally short-term contracts to prevent the penetration of an acid bolus into the jejunum. Conscientious studies have shown that AMA is proportional to BMI, i.e., a decrease in AMA is observed in all thin people. An analysis of 211 cases of SMAS made it possible to differentiate two types of diseases. In 101 patients, the disease occurred acutely 1–53 (8.2 ± 1.9) days after stressful situations, accompanied by a catabolic reaction and hypersecretion of hydrochloric acid. In 110 patients, SMAS developed 3-72 (17.2±3.2) months after the diagnosis of acid-dependent diseases. Conclusion: The analysis of the literature led to the conclusion that hypersecretion of hydrochloric acid causes damage to the upper level of the digestive system, including duodenal dyskinesia. One of the manifestations of duodenal dyskinesia is an increase in tone and hypertrophy of the Ochsner’s sphincter. The clinic of the disease depends on the varying degree of Ochsner’s sphincter dyskinesia. In severe cases, partial or complete intestinal obstruction. New ideas about the etiology and pathogenesis of the so-called SMAS have made it possible to propose a tactic for the diagnosis and treatment of Ochsner’s sphincter dyskinesia, where there is no place for surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Superior Mesenteric Artery Syndrome Results From Hypersecretion of Hydrochloric Acid

Levin

2024

Preprint

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Understanding the diagnosis of superior mesenteric artery syndrome: analysis of the location of duodenal impression on upper gastrointestinal studies

Caterine,

Patil,

Takrouri

et al. 2023

Pediatr Radiol

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Background Upper gastrointestinal (GI) contrast studies are frequently requested to aid superior mesenteric artery syndrome diagnosis, a rare entity. Compression of the third duodenal part is expected to be mid-to-left of the midline where the superior mesenteric artery arises from the aorta; however, a duodenal impression to the right of the midline due to normal anatomic impression by the inferior vena cava (IVC) is often encountered and frequently misdiagnosed. Objective The purpose of this study was to determine the frequencies of (1) normal right-of-midline duodenal impressions and (2) mid-to-left of midline compressions in upper GI studies in a tertiary pediatric referral center. Materials and methods All upper GI studies performed at our institution over 2 years were retrospectively evaluated to determine whether the duodenum had vertical duodenal impression to the right of the vertebral midline, mid-to-left of the vertebral midline, or no identifiable duodenal impression at all. Results In total, 538 upper GI studies were included in this analysis. A total of 275 male and 247 female patients between 0 and 17 years of age (median: 6 years, range: 1 month-17 years) were included. Of 538 total upper GI studies, there were 240 studies (44.6%) with a right-of-midline impression. There were only 10 studies (1.9%) with a mid-to-left of midline compression, and 9/10 also showed a concurrent right-sided impression sign. Conclusion Right-of-midline duodenal impression is a normal anatomic finding caused by the IVC and should not be confused with superior mesenteric artery syndrome. In the presence of an appropriate clinical context, proximal duodenal dilation, “to-and-fro” motion of contrast, and duodenal impression at mid-to-left of midline, a diagnosis of superior mesenteric artery syndrome should be considered. Graphical Abstract

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Unusual Etiologies for Vascular Duodenal Compression Mimicking the Superior Mesenteric Artery (SMA) Syndrome: The SMA-Like Syndrome

Abstract: We report a series of nine cases of unusual etiologies for vascular duodenal compression that do not meet the diagnostic criteria for superior mesenteric artery (SMA) syndrome and propose that “SMA-like syndrome” be used to classify these vascular duodenal compression cases.

Cited by 2 publications

References 15 publications

Superior Mesenteric Artery Syndrome Results From Hypersecretion of Hydrochloric Acid

Superior Mesenteric Artery Syndrome Results From Hypersecretion of Hydrochloric Acid

Understanding the diagnosis of superior mesenteric artery syndrome: analysis of the location of duodenal impression on upper gastrointestinal studies

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