Superior mesenteric artery syndrome: diagnosis and treatment from the gastroenterologist's view

Lippl, Florian; Hannig, Christian; Weiß, Wolfgang; Allescher, Hans–Dieter; Classen, Meinhard; Kurjak, Manfred

doi:10.1007/s005350200101

Cited by 137 publications

(131 citation statements)

References 17 publications

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“…3 The risk factors which causes this syndrome can be summarized as: catabolic states leading to severe loss of weight using externally belts and casts and compression inside the abdomen and hypertension of mesenteric artery. 4 Radiographic studies are needed to pinpoint the existence of superior mesenteric artery syndrome. For diagnostic purpose series of upper gastrointestinal tests, magnetic resonance (MR) angiography computed tomography (CT) scan or CT angiography, conventional angiography, and endoscopy ultrasonography have been done.…”

Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery syndrome: a new concept in the treatment

Sivakumar

Arunprasath

Padmasini

2017

Int J Contemp Pediatr

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Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery syndrome: a new concept in the treatment

Sivakumar

Arunprasath

Padmasini

2017

Int J Contemp Pediatr

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“…3 The incidence of this condition varies form 0.013-0.3% of the barium series of the upper GI tract. 3,6,8 Normally the aortomesenteric angle and aorto-mesenteric distance is 25°-60° and 10 to 28 mm respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Other causes include an abnormal high , fixed position of ligament of Treitz , unusually low origin of the SMA, a short ligament of Treitz and decrease of the aorto-mesenteric angle causing compression of 3rd part of duodenum by peritoneal adhesions and is due to loss of retroperitoneal fat which normally acts like cushion around the SMA. [4][5][6][7] Patient predominantly presented with weight loss and vomiting depending on the cause and degree of duodenal compression. Generally literature says that, the symptoms are relieved by lying prone/ left lateral decubitus, but there was no relief in our case.…”

Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery syndrome

2017

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Superior mesenteric artery syndrome (SMAS) is a rare condition caused by compression of the transverse portion of the duodenum between the superior mesenteric artery (SMA) and the aorta, causing symptoms of duodenal outflow obstruction. We report a case of superior mesenteric artery syndrome in a 25-year-old female associated with rapid loss of weight and intermittent vomiting and resulting in severe duodenal compression that necessitated surgical treatment.

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“…This angle remains open due to the presence of retroperitoneal fat (3,4). When this retroperitoneal fat is reduced, mainly secondary to clinical conditions that generate severe weight loss, compression of the duodenum could result.…”

Section: Discussionmentioning

confidence: 99%

Acute pancreatitis and superior mesenteric artery syndrome

Sihuay-Diburga

Accarino-Garaventa

Vilaseca-Montplet

et al. 2013

Rev. esp. enferm. dig.

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Superior mesenteric artery syndrome (SMAS) has been proposed as a rare cause of proximal bowel obstruction resulting from compression of the third portion of the duodenum secondary to narrowing of the space between the aorta and superior mesenteric artery. The main risk factors associated with SMAS are significant weight loss, corrective spinal surgery and congenital or acquired anatomic abnormalities. Its association with acute pancreatitis has been reported in very few cases. We present a critical review of this topic, with the report of a patient allegedly diagnosed of SMAS and acute pancreatitis.Key words: Superior mesenteric artery syndrome. Pancreatitis. CASE REPORTA 28-year-old Caucasian woman, with a medical history of cerebral palsy, spastic quadriplegia and seizures treated with phenobarbital, was admitted to the emergency department with a 24 hour history of abdominal distension, bilious vomiting and fever of 38 °C. On admission, the patient's vital signs were stable. Physical examination revealed a cachectic young woman (BMI: 18 kg/m 2 ), with a soft, non-tender but distended abdomen, predominantly in the epigastrium.Under the suspicion of proximal bowel obstruction, a nasogastric tube was inserted, with abundant bilious fluid output, and additional tests were performed: Abdominal X-ray showed dilatation of the stomach without air-fluid levels; laboratory data showed hemoglobin 18 g/dL with MCV 88 fL, white cell count 17,200 with neutrophilia 87 %, amylase 500 U/L (normal < 53 U/L), lipase 628 U/L (normal < 67 U/L), trypsin 6,990 μg/L (normal < 440 μg/L), and amylasuria 480 U/L (normal < 350 U/L); indicators of renal and liver function and electrolytes were normal. Abdominal X-ray after gastografin administration revealed a grossly dilated stomach and duodenum with late passage of contrast to the small intestine.In view of these findings suggestive of partial bowel obstruction at duodenal level, a CT scan performed showed gastric and duodenal distension to the aortomesenteric angle, with a reduced distance between the aorta and SMA (Fig. 1). Glandular necrosis of the head and tail of the pancreas with fat infiltration and free fluid in both paracolic gutters consistent with Balthazar grade D was also observed. The intra-and extra-hepatic biliary tract was normal (Fig. 2).During admission, the patient was maintained on total parenteral nutrition, and a continuous nasogastric aspiration tube was inserted which yielded a high debit (around 2,000 mL/day) of bilious liquid. Blood cultures were negative and the fever self-limited. Serial determinations of amylasuria oscillated between 1,000 and 4,500 U/L for around 10 days and the condition resolved gradually after 3 weeks.An abdominal CT scan performed prior to discharge showed resolution of the pancreatitis and dilatation of the stomach and duodenum. To rule out other possible causes of pancreatitis, abdominal US was performed, which was normal, and serology for some viruses (CMV, EBV, herpes virus, measles, rubella and varicella zoster) which we...

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Superior mesenteric artery syndrome: diagnosis and treatment from the gastroenterologist's view

Abstract: Pathogenesis, diagnostic procedures, and therapy are reviewed in order to draw attention to this rare entity.

Cited by 137 publications

References 17 publications

Superior mesenteric artery syndrome: a new concept in the treatment

Superior mesenteric artery syndrome: a new concept in the treatment

Superior mesenteric artery syndrome

Acute pancreatitis and superior mesenteric artery syndrome

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