Superior mesenteric artery syndrome: A review of the literature

England, J P S; Li, Natasha

doi:10.1002/emp2.12454

Cited by 7 publications

(9 citation statements)

References 18 publications

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“…Three-dimensional imaging modalities enable demonstration of direct compression of the LRV, most specifically via an increased LRV diameter ratio (hilar to aortomesenteric) ≥4.9 18. The ‘beak sign’ (narrowing of the LRV at the aortomesenteric portion) is also characteristic of direct LRV compression 18 19. In addition, visualisation of aortomesenteric angle (AMA) narrowing <41° and the indirect effects of LRV compression, including venous collateralisation and left ovarian vein reflux with varicosities, can support diagnosis 7 18…”

Section: Discussionmentioning

confidence: 99%

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Atypical case of coexistent vascular compression syndromes: median arcuate ligament syndrome and nutcracker syndrome

Donnelly,

Turner,

Davies

2023

BMJ Case Rep

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Vascular compression syndromes, including median arcuate ligament syndrome (MALS) and nutcracker syndrome (NCS), are poorly understood and frequently delayed diagnoses. This case describes a young adult female presenting with chronic vomiting, abdominal pain and weight loss, with dependence on nasogastric feeding. Subsequent to her gastrointestinal symptoms, she developed haematuria and orthostatic intolerance. Investigations confirmed NCS and possible MALS, with superadded gastroparesis and bradygastria. Under the joint care of general and vascular surgeons, she underwent a gastrojejunostomy and panelled renocaval bypass which led to partial resolution of her symptoms. It is hypothesised that gastroparesis may have been caused by MALS via a neurogenic mechanism, or coexistent compression of the duodenum by the superior mesenteric artery. This case highlights the difficulty in diagnosis of vascular compression syndromes, the overlap between the conditions and the potential for multiple coexistent conditions which complicate diagnosis and lead to increased lead-time and morbidity for patients.

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Section: Discussionmentioning

confidence: 99%

“…The coexistence of vascular compression syndromes has been reported in only a few cases,20 typically NCS and SMAS due to the common aetiology; the LRV and duodenum exist in the same anatomical plane between the aorta and SMA 19 20. In spite of their shared aetiology, concomitant NCS and SMAS is seldom reported 20.…”

Section: Discussionmentioning

confidence: 99%

Atypical case of coexistent vascular compression syndromes: median arcuate ligament syndrome and nutcracker syndrome

Donnelly,

Turner,

Davies

2023

BMJ Case Rep

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“…Superior mesenteric artery syndrome (SMAS) is a rare and unusual disease. It is considered to be a form of chronic duodenal ileus [1] and represents a duodenal obstruction secondary to the impingement of the third portion of the duodenum between the abdominal aorta (AA) and the superior mesenteric artery (SMA) due to decreased intraabdominal fat [2]. Clinical symptoms raise suspicion for this diagnosis which can be confrmed by radiological testing [3]; however, the diagnosis remains challenging and the approach for SMAS diagnosis remains controversial [1].…”

Section: Introductionmentioning

confidence: 99%

Deadly Aspiration Pneumonia Secondary to Superior Mesenteric Artery Syndrome

Akel,

Daou,

Jamal

et al. 2024

Case Reports in Gastrointestinal Medicine

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Superior mesenteric artery syndrome (SMAS) is a rare and unusual disease, suspected clinically and confirmed radiologically. It represents a duodenal obstruction secondary to the impingement of the third portion of the duodenum between the abdominal aorta (AA) and the superior mesenteric artery (SMA) due to decreased intraabdominal fat. High morbidity and mortality rates are linked to missed or late diagnosis that can lead to complications, such as gastric perforation and gastric hemorrhage. We present the case of a 33-year-old man who was not previously known to have a SMAS, who presented to the emergency department with signs of septic shock, complaining of fever and respiratory symptoms for several days. Investigations showed aspiration pneumonia secondary to an upper gastrointestinal obstruction with signs of SMAS on a computed tomography (CT) scanner. Acute and rapid deterioration led to cardiac arrest and death. Through this article, we highlight the importance of early and correct diagnosis of SMAS which can sometimes be challenging, since no number is strictly diagnostic and radiological images must be interpreted in light of the clinical history and physical examination.

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“…6 Medical management in form of refeeding and weight gain is the mainstay of treatment with the ultimate aim to regain the lost intraabdominal fat. 7 SMA syndrome precipitating in the postoperative period of major emergency abdominal surgery is a much rarer event. We present a case of SMA syndrome in the early postoperative period in a young woman.…”

Section: Introductionmentioning

confidence: 99%

Superior Mesenteric Artery Syndrome as a Rare Cause of Postoperative Intractable Vomiting: A Case Report

Edem¹,

Goswami²,

Karki³

et al. 2023

CEG

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Background: Superior mesenteric artery syndrome is a very rare cause of proximal intestinal obstruction. The objective of this clinical case report is to highlight that this unusual condition can occur in the early postoperative period and medical management may completely cure the condition. Clinical Case: A middle-aged female who was being treated for pulmonary tuberculosis underwent exploratory laparotomy with limited ileal resection and a loop ileostomy for multiple ileal perforations. Postoperatively, she was restarted on anti-tubercular drugs (ATD) but developed a drug reaction, recurrent bilious vomiting, and jaundice and ATD had to be stopped. But her vomiting did not abate and she progressively developed septicemia. An abdominal CT scan diagnosed Wilkie's syndrome, and she was managed nonoperatively by decubitus, parenteral nutrition, and nasojejunal tube feeding supplemented with prokinetics and antibiotics. But her sepsis did not resolve. Intraoperative histopathology suggested Candida infection, and she recovered only after systemic antifungal therapy. Discussion: Debilitation conditions like tuberculosis cause weight loss and loss of intra-abdominal fat pad, which is known to precipitate SMA syndrome. However, its presentation in the early post-operative period is rare. Symptoms may vary from non-specific abdominal fullness and weight loss to features of acute bowel obstruction. CECT of whole abdomen can help in confirming the diagnosis. SMA syndrome is often not considered in differential diagnosis and can delay treatment. Medical management is the mainstay treatment option, although surgery is reserved for cases, which fail medical treatment. Conclusion: High suspicion is needed to diagnose SMA syndrome in the postoperative period, which precipitates with intractable bilious vomiting. Medical management may be curative. The precipitating factor for SMA syndrome should also be addressed to improve the overall patient outcome.

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Superior mesenteric artery syndrome: A review of the literature

Cited by 7 publications

References 18 publications

Atypical case of coexistent vascular compression syndromes: median arcuate ligament syndrome and nutcracker syndrome

Atypical case of coexistent vascular compression syndromes: median arcuate ligament syndrome and nutcracker syndrome

Deadly Aspiration Pneumonia Secondary to Superior Mesenteric Artery Syndrome

Superior Mesenteric Artery Syndrome as a Rare Cause of Postoperative Intractable Vomiting: A Case Report

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