Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy according to the Controlling Nutritional Status Score

Takehara, Kazuhiro; Sakamoto, Kazuhiro; Takahashi, Rina; Kawai, Masaya; Kawano, Shingo; Munakata, Shinya; Sugimoto, Kiichi; Takahashi, Makoto; Kojima, Yutaka; Fukunaga, Tetsu; Kajiyama, Yoshiaki; Kawasaki, Seiji

doi:10.1159/000484129

Cited by 10 publications

(7 citation statements)

References 13 publications

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“…As the cause of SMAS might be related to loss of intraabdominal adipose tissue, the nutritional status of patients with SMAS requires attention. A previous report has described a 78-year-old woman diagnosed with SMAS after a laparoscopic right hemicolectomy for cecal cancer, whose condition was improved by EN therapy, delivered with a feeding tube, passed through the narrow segment, and placed into the jejunum [5]. The authors used the Controlling Nutritional Status score to assess the patient's nutritional status.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Given its lack of specific symptoms, SMAS diagnosis remains challenging. Currently, SMAS is diagnosed based on a computed tomography scan or an upper gastrointestinal examination series, showing the narrowing of the branch angle between the aorta and the SMA or the obstruction of the third portion of the duodenum [5]. It has been reported that the aorta -SMA angle in patients with SMAS is 6-22°, compared to 25-60° in healthy persons [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy: A Retrospective Case-Series Study in a Single Institution

Wan¹,

Zhang²,

Yang³

et al. 2020

Ann Nutr Metab

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Introduction: Superior mesenteric artery syndrome (SMAS) is a relatively rare cause of chronic duodenal obstruction, owing to the compression of the third portion of the duodenum. Objectives: This retrospective study aims to discuss the efficacy of enteral nutrition (EN) therapy in nutritional status and symptom improvement at a short-term follow-up for SMAS patients. Methods: We retrospectively analyzed clinical data of patients diagnosed as SMAS and treated with EN from September 2012 to January 2019. Results: Twenty-six patients were included (16 women; mean age 24.96 ± 11.77 years), none was excluded, and one was lost to follow-up. The patients' mean body weight was 40.94 ± 10.16 kg, mean weight loss 11.73 ± 7.58 kg, and mean body mass index (BMI) 14.82 ± 2.52 kg/m 2 . The mean duration of EN therapy was 10.10 ± 4.66 months. Serum level of nutritional indicators, BMI and body weight increased after EN therapy. During a median follow-up of 24 months (9-44) after EN therapy, the mean symptom score decreased from 24.28 ± 9.57 to 8.06 ± 8.29 (p < 0.0001), and 65% of patients' symptoms resolved and 15% of patients' symptoms improved. In total, 16 complications occurred, including tube blockage, peristomal wound infections, peristomal leakage, granulomas, and nasopharyngeal pain. Conclusion: EN therapy may be an effective option for SMAS patients. While it might not remove all symptoms, it can improve the nutritional status to support subsequent treatments.

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Section: Discussion/conclusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy: A Retrospective Case-Series Study in a Single Institution

Wan¹,

Zhang²,

Yang³

et al. 2020

Ann Nutr Metab

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“…Besides nutritional supporting [17] and decubitus position, the rehabilitating practice after discharge is also important to reduce recurrence. We recommend the rehabilitating practice after discharge, such as appropriate swimming, which is beneficial to enhance the abdominal wall and reduce the frequency of recurrence, especially for female patient.…”

Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery syndrome coexists with Nutcracker syndrome in a female: a case report

Shi

et al. 2019

BMC Gastroenterol

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BackgroundSuperior mesenteric artery (SMA) syndrome, also known as Wilkie’s syndrome or Benign duodenal stasis, is a rare benign disease. It could threaten the life if the manifestation is severe and the treatment is inappropriate. In the patients with SMA syndrome, the third portion (transverse part) of the duodenum is compressed externally between the SMA and abdominal aorta (AA) leading to duodenal stasis and gastrointestinal obstruction. SMA syndrome may rarely combine with Nutcracker syndrome when left renal vein (LRV) was compressed between SMA and AA.Case presentationA 32-year-old female patient presented with complaints of gradually severe bloating, epigastric pain, left flank ache, nausea and occasional vomiting of 1 month’s duration. The epigastric and left flank ache was aggravated when the patient was supine and relieved in a prone or left lateral decubitus. The abdominal bloating was associated with early satiety. The vomiting always started 40 min after meal. The patient gave a history of urine stone with drotaverine hydrochloride tablets treatment for two weeks before the gastrointestinal symptoms arising. The patient had no significant surgical history, but had a rapid weight loss of approximately 10 kg with a body mass index (BMI) from 21 kg/m2 to less than 18 kg/m2 over the last two months. An abdominal examination revealed upper abdominal tenderness and distention. The urine routine examination showed no significant abnormality. The findings of initial blood tests and other laboratory investigations were unremarkable.ConclusionsThis case reports a female patient with SMA syndrome with Nutcracker syndrome predisposed by Antispasmodics. We highlight the importance of the combination therapy of long-term nutritional supporting and prokinetic agents. Rehabilitating practice after discharge is beneficial to reduce recurrence.

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“…Management of SMA syndrome varies from medical to surgical procedures aiming to promote weight gain and to increase retroperitoneal fat tissue. Medical management via enteral nutrition given through a feeding tube bypassing the obstruction or a parenteral nutrition with or without prokinetic agents are the preferred strategies and has been proven to be successful in certain cases [20,21]. Knee-chest or side-lying positional change after a meal had been tried to provide partial obstruction relief by widening the aortomesenteric angle [22,23].…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury Caused by Superior Mesenteric Artery Syndrome

Kazmin

Kamaruzaman

Wong

et al. 2020

Case Reports in Nephrology

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Background. Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction leading to acute kidney injury (AKI). Methods. We report a case of 23-year-old army personnel who presented with persistent vomiting leading to severe hypokalaemia, metabolic alkalosis, and acute kidney injury resulting in cardiorespiratory arrest. Results. After successful resuscitation, he was supported with haemodialysis and aggressive electrolytes correction. He was repeatedly not able to tolerate nasogastric (NG) tube feeding and computerised tomography of abdomen was performed, and the diagnosis of SMA syndrome was made. Gastroscopy examination revealed duodenal ulcer at D1, pinhole D1-D2 junction, but there was no evidence of intraluminal mass or lesions leading to upper gastrointestinal obstruction. A nasojejunal tube was inserted to bypass the narrow segment of the duodenum, and he was put on nutritional support. He was subsequently weaned off dialysis support as his renal function gradually improved and later on normalised. He remains symptoms free, and he gained five kilograms in four months after discharge. Conclusions. SMA syndrome is a rare cause of upper gastrointestinal obstruction but should be considered as a differential diagnosis in a patient who presented with recurrent vomiting and AKI with metabolic alkalosis.

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Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy according to the Controlling Nutritional Status Score

Cited by 10 publications

References 13 publications

Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy: A Retrospective Case-Series Study in a Single Institution

Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy: A Retrospective Case-Series Study in a Single Institution

Superior mesenteric artery syndrome coexists with Nutcracker syndrome in a female: a case report

Acute Kidney Injury Caused by Superior Mesenteric Artery Syndrome

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