Superior Mesenteric Artery Syndrome

Abstract

A 63-year-old female presented to our department complaining of epigastric pain, nausea and vomiting. Symptoms started after a significant loss of weight and persisted despite treatment, leading to hospitalization for dehydration and renal failure due to protracted vomiting. During hospitalization, no pathology could be identified and the patient was discharged. Symptoms persisted and she was eventually readmitted. Superior mesenteric artery syndrome was diagnosed based upon clinical suspicion and barium studies. She was subjected to duodenojejunostomy after failure of conservative treatment. Her immediate postoperative course was uneventful and the patient was well during her two-year follow-up. Clinicians should be suspicious of superior mesenteric artery syndrome, albeit rare, and be aware of its treatment, which is either conservative or surgical.

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

“…Chief complaints of the patients with SMA syndrome are epigastric pain, nausea, eructation, voluminous vomiting, and postprandial discomfort. Imaging findings in the form of barium findings are dilation of the first and second part of the duodenum with an abrupt narrowing at the third portion, delayed gastroduodenal emptying and ant peristaltic waves proximal to the obstruction which may be relieved by a change in position, especially left lateral decubitus position [12]. USG of the abdomen may be helpful in measuring the angle of the superior mesenteric artery and the aortomesenteric distance but is difficult in obese patients and those with gaseous abdomen [13].…”

Hypothalamic Germinoma Masquerading as Superior Mesenteric Artery (Sma) Syndrome

“…SMA syndrome (Wilkie's syndrome) is an uncommon and often unrecognized complication of severe weight loss (1).We report an unusual surgical presentation of a rare endocrine disorder (hypothalamic lesion) presenting with emaciation and upper intestinal obstruction. Our patient was diagnosed with SMA syndrome based on CT confirmation of a narrowed aortomesenteric angle (16°) and evidence of proximal duodenal dilatation and extrinsic compression of D3 based on an esophagogastroduodenoscopy.…”

“…Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction with prevalence in the general population of 0.03 to 0.3% (1). As a result of man's upright posture, the SMA, instead of branching off perpendicular to the abdominal aorta, forms an acute downward angle of 25 to 60° (2,3).…”

“…SMA syndrome has also been attributed to spinal surgery requiring body casting and external compression of the duodenum by vascular abnormalities of the aorta/mesenteric artery (2). The diagnosis of SMA syndrome is made by imaging studies that confirm a reduced aortomesenteric angle in the setting of upper intestinal obstruction (1,2,3). While there have been reports of poorly controlled diabetes mellitus and thyrotoxicosis resulting in weight loss as being associated with SMA syndrome (2,3), there are currently few published reports of hypothalamic/ pituitary lesions presenting with SMA syndrome.…”

Laparoscopic Roux‐en‐Y duodenojejunostomy for superior mesenteric artery syndrome in a 6‐year‐old girl: A case report of a new minimally surgical technique for children

“…However, this type of procedure has some disadvantages. In this case, we selected Roux‐en‐Y duodenojejunostomy to avoid reverse peristalsis; it was recently reported that duodenojejunostomy with side‐to‐side anastomosis does not alleviate vomiting, possibly due to reverse peristalsis being greater than direct peristalsis in some cases . Even though creating an additional Roux‐en‐Y anastomosis might be time‐consuming, it is a more physiological reconstruction that avoids blind loop syndrome and jejunal loop twisting .…”