Superior mesenteric artery syndrome: A case report

Abstract

Context:Superior mesenteric artery syndrome is a life- threatening upper gastrointestinal disorder due to compression of duodenum as it poses a difficult diagnostic dilemma. Third part of duodenum is in fixed compartment bounded anteriorly by the root of mesentery and superior mesentery artery and posteriorly by the aorta and lumbar spine. On barium contrast study and abdominal computerized tomography (CT) showed the dilatation of second part of duodenum and compression of the third part of duodenum between aorta and superior mesentery artery.Case Report:A 22 year young asthenic man admitted with the complaint of recurrent abdominal pain, epigastric fullness, and vomiting and weight loss. Abdominal examination revealed epigastric fullness and hyper peristaltic bowel sounds. Upper gastrointestinal barium study showed a dilated stomach with dilated second part of the duodenum and cut off at the third part of duodenum with no intrinsic mucosal abnormalities. There was no relief of obstruction in the left lateral decubitus or prone position. Conservative treatment was tried for one month but failed. Intra-operative findings confirmed the extrinsic obstruction of third part of duodenum with distension of 2nd part. A retrocolic duodenojejunostomy, side to side anastomosis done. In post-operative follow up, patient was symptom free.Conclusion:Superior mesentery artery syndrome is a life threatening disease. It should be treated as soon as possible. Conservative trial can be given but Surgery is the treatment of the choice.

Laparoscopic Management of Duodenal Obstruction Resulting From Superior Mesenteric Artery Syndrome

“…1,4,6 The disease occurs more often in females than males, at a ratio of 3:2, and often affects younger individuals between the ages of 10 and 39 years. Normally, the SMA forms an approximately 45°angle (range, 38°-65°) as it comes off the aorta.…”

“…1,2 Computed tomography has now replaced angiography as the standard for diagnosis of SMA syndrome. [1][2][3][4][5][6] In this series, 11 of 12 patients were diagnosed with SMA syndrome using a combination of upper gastrointestinal series and computed tomography. One young patient underwent upper gastrointestinal series with magnetic resonance imaging for diagnosis to avoid gonadal radiation.…”

Superior mesenteric artery syndrome: A rare but life threatening disease

“…Normally, the presence of fat and lymphatic tissues around the SMA provides protection to the duodenum against compression. The protection of SMA is diminished among cachectic patients who have decreased fatty tissue around SMA resulting in angulation and reduction in the distance between the aorta and the SMA [3], [4], [5]. His weight was 3% percentile and height was 90–97% percentile.…”

Wilkie’s Syndrome:A Rare Cause Of Duodenal Obstruction

“…Surgery may be considered if conservative treatment fails 8 . The first proposed surgery for SMAS was described as duodenojejunostomy by Bloodgood 9 . Duodenojejunostomy is effective in the majority of patients 8 .…”