Diagnosis Of Superior Mesenteric Artery Syndrome Research Articles

Superior mesenteric artery syndrome in oncology: Report of two cases and review of the literature

A rare cause of abdominal pain is the superior mesenteric artery syndrome (SMAS), characterized by an extrinsic compression of the third portion of the duodenum by the superior mesenteric artery. It occurs in the context of rapid weight loss, because of the decrease of intra-abdominal fat causing a reduction in the exit angle of this important vascular structure. Cancer patients frequently present with weight loss, often severe, making them a population at risk of presenting this syndrome. Because symptoms are vague and could be secondary to oncologic treatments, the diagnosis of SMAS is often overlooked. We present two cases of oncology patients evaluated in the National Cancer Institute in Chile who presented with symptoms suggestive of SMAS, weight loss greater than 5 kg in a short period of time associated with abdominal pain and vomiting. Both cases were confirmed by images [computed tomography (CT) scan] and treated with nutritional support only. We present both cases along with a brief review of the literature on this rare syndrome, which is usually a diagnostic challenge.

Strong Procedure for Superior Mesenteric Artery Syndrome in Children: A Case Report

Superior mesenteric artery syndrome (SMAS) or Wilkie syndrome is a rare anomaly resulting from extrinsic compression of the third duodenal segment by the superior mesenteric artery (SMA) anteriorly and the abdominal aorta posteriorly. Clinically, SMAS is characterized by acute or chronic upper obstruction associated with intermittent abdominal pain. Abdominal computed tomography is the key examination for establishing the diagnosis. Although initial management is medical, surgery is required if this fails. We report the case of a 12-year-old girl admitted for acute occlusive syndrome associated with abdominal pain, in whom the diagnosis of SMAS was retained. Treatment consisted of Strong's surgical technique after failure of medical treatment with good evolution. Our case reports that in cases of SMAS where medical treatment is ineffective, less invasive surgical options such as Strong's technique may be considered to facilitate rapid recovery while minimizing the risk of complications associated with more complex procedures involving bowel resection and anastomosis.

Superior Mesenteric Artery Syndrome: A Case Study

Superior mesenteric artery (SMA) syndrome (known as Wilkie's syndrome) is a rare cause of upper gastrointestinal obstruction. It is an acquired disorder in which acute angulation of the SMA causes compression of the third part of the duodenum between the SMA and the aorta. This is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a 25-year-old male who presented with intermittent abdominal pain and intractable vomiting following significant weight loss, he developed acute high intestinal obstruction, which was diagnosis by a CT scan. This case emphasizes the challenges in the diagnosis of SMA syndrome and the need for increased awareness of this entity. This will improve early recognition in order to reduce irrelevant tests and unnecessary treatments.

Laparoscopic Hand-Sewn Duodenojejunostomy for Superior Mesenteric Artery Syndrome Using 3D-4K Image - A Case Study

Background: Superior mesenteric artery (SMA) syndrome, also known as wilkie’s syndrome, is a rare condition characterized by vascular compression of third part of the duodenum that leads to duodenal obstruction. Traditionally, open or laparoscopic stapled duodenojejunostomy is recommended when conservative management failed. We report a 3D-4K image hand-sewn duodenojejunostomy (DJ) for the treatment of SMA syndrome. Materials and Methods: A 13 years old patient presented with anorexia, post prandial vomiting, dull abdominal pain & weight loss for 6 years. Upper GI endoscopy revealed duodenal stenosis and Barium follow through demonstrated obstruction to the third part of the duodenum. Ultrasound examination revealed gastric & duodenal dilatation. With these clinical and radiological findings, the diagnosis of SMA syndrome was suspected. He was identified as a candidate for a duodenojejunostomy. 3D-4K image system was used for superior image quality and binocular depth perception and a laparoscopic hand-sewn duodenojejunostomy performed on september 20, 2020 Results: Diagnostic laparoscopy detected SMA syndrome. Laparoscopic hand-sewn duodenojejunostomy took 120 minutes time. There were no intraoperative complications. The blood loss was minimum. The postoperative course was uneventful with resolution of duodenal obstruction. The patient discharged on 6th postoperative day. He gained 10 kg weight 6weeks after surgery. Conclusion: 3D-4K image laparoscopic hand-sewn duodenojejunostomy as a surgical option for the treatment of SMA syndrome is safe, cost effective, feasible, and valid alternative to open and laparoscopic stapled technique with added benefits of a minimally invasive approach. Additionally hand-sewn anastomosis ensures good tissue approximation. Of course it is time consuming and needs expertise in intracorporeal suturing. 3D-4K image technology makes this difficult procedure easier. J Bangladesh Coll Phys Surg 2022; 40: 68-71

Normal values of angle and distance between the superior mesenteric artery and aorta in Iraqi population: A single centre study.

IntroductionThe diagnosis of the superior mesenteric syndrome depends on measuring the distance and angle between the superior mesenteric artery (SMA) and aorta on CT scan in the presence of duodenal compression. Studies examining the normal range of these measurements are scarce and none of them was conducted on the Iraqi population. The aim of this study was to assess the values of aorto‐SMA angle (AMA) and aorto‐SMA distance (AMD) in asymptomatic patients to define the normal range in the Iraqi population and to compare it with the normal published range and different demographical values and body mass index (BMI).MethodsA total of 333 patients referred to arterial phase CT examinations for reasons unrelated to gastrointestinal tract were recruited. On axial and reformatted sagittal–oblique images, the angle and the distance between SMA and aorta were measured at the location where the duodenum crosses.ResultsBoth AMA and AMD had a wider range 10–147° and 4–44 mm, respectively, compared to the literature reported range. There was a significant reduction in AMA and AMD values in underweight participants (AMA, P < 0.001; and AMD, P = 0.014) and in female patients (AMA and AMD, P < 0.0001) and those who were younger than 20 (AMA, P = 0.014; and AMD, P = 0.001). A moderate correlation (r = 0.507, P < 0.0001) was found between AMA and AMD values. The correlation of BMI with AMD values was moderate (r = 0.46), and with AMA was weak (r = 0.23) (P < 0.0001).ConclusionVery low values of AMA and AMD can occur in normal asymptomatic patients without compressing the duodenum, which warrants further follow‐up studies. Evaluating normal values of AMA and AMD in the Iraqi population can help in providing a reference for CT‐based diagnosis of SMA syndrome.

Wilkie's syndrome in an adolescent female patient

&lt;p&gt;One of the rare cases of the upper gastrointestinal tract obstruction is superior mesenteric artery syndrome (SMAS) but potentially life-threatening if not recognized early. It is due to loss of fat pad between the aorta and SMA which will lead to a compression of the third portion of the duodenum. It has a different angle which will lead to different presentations as well as severity. We are reporting the 15 year-old (y/o) female who is medically free, presented to the emergency department (ED) complaining of severe colicky epigastric abdominal pain for the last 5 days in the epigastric area. The diagnosis of SMAS was made after clinical and radiological investigation. After proper supportive resuscitative measures, definitive management of the surgery was done by laparoscopic approach (duodenojejunostomy). The diagnosis of SMA syndrome is considered challenging due to many presentations and might be confused with other clinical conditions. Unless early diagnosed and treated, the outcome might be catastrophic. Medical treatment is attempted first in many cases depending on the severity and presentation but if failed, surgery will be the best option.&lt;/p&gt;

Superior mesenteric artery syndrome masquerading as chronic gastric volvulus in a child with severe acute malnutrition: a case report

Superior mesenteric artery (SMA) syndrome is a rare cause of high intestinal obstruction. It is commonly seen in severely malnourished patients presenting with repeated episodes of vomiting. We report a case of SMA syndrome in a 3 years old male child provisionally diagnosed as chronic gastric volvulus with severe acute malnutrition. The diagnosis of SMA syndrome was confirmed on abdominal exploration. SMA syndrome is a rare case of intestinal obstruction in paediatric age group. Chronic malnutrition is one of the common causes of this entity. There should be a high index of suspicion for this syndrome when we encounter a child with severe malnutrition and recurrent vomiting.

Facts and fantasies about superior mesenteric artery syndrome: an unusual cause of intestinal obstruction

Superior mesenteric artery (SMA) syndrome (also known as Wilkie’s syndrome) is an unusual cause of proximal intestinal obstruction, attributable to vascular compression of the third part of duodenum between the superior mesenteric artery and the abdominal aorta due to acute angulation of SMA. It is a life threatening disease as it poses a diagnostic dilemma and often diagnosed by exclusion of other causes. It is an acquired disorder and is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a case of SMA syndrome in a 23 year young asthenic female patient, with a long history of recurrent abdominal pain, epigastric fullness, voluminous vomiting, and weight loss. Symptoms persisted for 1 year and the patient underwent extensive investigations, but to no avail. Thereafter she developed proximal intestinal obstruction, which unravelled her diagnosis. Abdominal examination revealed epigastric fullness, tenderness and hyper peristaltic bowel sounds. We performed small bowel enteroclysis, upper gastrointestinal series, abdominal computer-tomography (CT) and ultrasonography to establish the diagnosis. Conservative treatment was tried for one month but failed. There was no relief of symptoms in the left lateral decubitus or prone position. Finally, the patient successfully underwent Roux-en-Y duodenojejunal anastomosis with a postoperative favourable outcome. This case emphasizes the challenges in the diagnosis of SMA syndrome and the need for increased awareness of this entity. This will improve early recognition in order to reduce irrelevant tests and unnecessary treatments.

Superior mesenteric artery syndrome: a radiographic review.

To provide a review of the etiology, clinical presentation, and imaging findings of superior mesenteric artery (SMA) syndrome. A literature review of 24 relevant articles regarding SMA syndrome was performed. Clinicians and radiologists with a high index of suspicion based on symptomatology may pursue radiologic investigation in the form of upper gastrointestinal (GI) series and contrast-enhanced abdominal computed tomography (CT). Magnetic resonance imaging (MRI) and ultrasound (US) are less commonly utilized modalities in the work-up of SMA syndrome, but provide imaging alternatives without the use of ionizing radiation. Imaging can assist in diagnosis by demonstrating characteristic findings of reduced aortomesenteric angle, reduced aortomesenteric distance, gastroduodenal distention, bowel caliber narrowing at the takeoff of the superior mesenteric artery from the aorta, as well as delayed gastric emptying or positional obstruction observed with real time with fluoroscopy. SMA syndrome is a rare disease that can go unrecognized and undiagnosed, exacerbating weight loss in an already significantly malnourished patient population. The diagnosis of SMA syndrome must be based on clinical symptomatology correlated with radiographic information. Once diagnosed, SMA syndrome can be safely treated by conservative measures although occasionally requires invasive intervention in the form of enteral tube placement, percutaneous jejunostomy tube placement, total parenteral nutrition, ligament of Treitz lysis, or duodenojejunostomy.

Superior Mesenteric Artery Syndrome: A Rare Cause of Abdominal Pain

Introduction: Superior Mesenteric Artery Syndrome (SMAS) is an extremely rare, potentially life threatening cause of abdominal pain. First described in 1842, it has an incidence of < 0.3% in the general population with a mortality rate as high as 33%. It is caused by reduced mesenteric fat which leads to a decreased angle between the SMA and aorta, resulting in extrinsic compression of the third portion of the duodenum. Most common symptoms include abdominal distension, pain, nausea, vomiting, and weight loss. This case highlights the importance of considering the diagnosis of SMAS in a young, otherwise healthy patient presenting with postprandial vomiting, weight loss, and abdominal pain. Case Report: 22 year old female with no past medical history presented to the emergency department with vaguely localized, sudden onset abdominal pain and vomiting. On review of systems, she reported a five pound weight loss in the last several months that she attributed to poor eating habits and stress due to school. On physical exam, patients was tachycardic. Abdominal exam was significant for moderate epigastric and right upper quadrant abdominal tenderness with voluntary guarding. Laboratories were within normal limits. Computerized tomography of the abdomen and pelvis revealed a dilated mid third portion of the duodenum with a transition point as it passed between the superior mesenteric artery and aorta (Figure 1). This was highly suggestive of SMAS. Patient was treated with conservative management including nutritional support (enterally) resulting in improvement of the patient's symptoms.Figure: CT showing compression of the third part of the duodenum (arrow) between the superior mesenteric artery and the aorta, with consequent upstream dilatation (asterisk).Discussion: In this case, the diagnosis of SMAS was straight forward as the patient's CT imaging of the abdomen and pelvis done in the ED were highly suggestive of the diagnosis. Yet, CT imaging may not always be as supportive of the diagnosis as seen here, necessitating additional work up (further imaging, EGD). The majority of SMAS cases documented in the medical literature usually describe a period of weight loss, either unintentional or intentional, prior to the onset of symptoms, which was demonstrated in this case presentation. It is equally important to recognize the psychological factors that may be involved in SMAS as its association with eating disorders and drug abuse is well documented.

Superior mesenteric artery syndrome - A clinicoradiologic case report

Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction due to compression of the third part of duodenum between SMA and aorta. Clinical suspicion and radiological findings are playing important role in the diagnosis of SMA syndrome. We report here the clinicoradiologic findings in a case of 66-year-old Indian male. In our case, abdominal aortic tortuosity in an elderly patient was the cause for SMA syndrome.

Superior mesenteric artery syndrome – a rare diagnosis for common upper gastrointestinal symptoms

Superior mesenteric artery (SMA) syndrome is a rare acquired vascular compression disorder in which acute angulation of the SMA results in compression of the third part of the duodenum, leading to intestinal obstruction. This is typically caused by an angle of 6 – 25° between the abdominal aorta and the SMA, in comparison with the normal range of 38 – 56°, as a result of a lack of retroperitoneal visceral fat (mesenteric fat). In addition, the aortomesenteric distance is 2 – 8mm as opposed to the typical 10 – 20mm. Here we report the case of an 11-year-old girl who presented with frequent attacks of non-specific abdominal pain over a few years, who had been treated symptomatically without a clear diagnosis. However, in the last admission, she presented to our hospital with symptoms of subacute small bowel obstruction including bilious vomiting and epigastric pain that prompted extensive investigations including multislice abdominal computerized tomography with oral and intravenous contrast. This scan confirmed the diagnosis of SMA syndrome.

Superior mesenteric artery (Wilkie’s) syndrome: a rare cause of upper gastrointestinal system obstruction

Background Superior mesenteric artery syndrome (SMAS) results from the compression of the third part of the duodenum between the aorta and the proximal part of the superior mesenteric artery (SMA). Clinical presentation of SMAS is characterized by the dilatation of the proximal part of the third part of the duodenum. SMAS is a rare cause of the upper gastrointestinal system (UGS) obstruction. In this study, we aimed to present our clinical experience in the treatment of five patients with SMAS, which is a rare clinical condition requiring surgery.Patients and methods The retrospective study included five patients who were treated due to SMAS at our clinic between January 2010 and January 2014.Results All the patients were underweight, with a mean BMI of 15.73 (14–16). The clinical symptoms included epigastric pain after food intake, large volume bilious emesis, early satiety, failure to gain weight, indigestion, esophageal reflux, sense of fullness, and persistent weight loss. SMAS was diagnosed using barium meal studies, upper gastrointestinal endoscopy, abdominal ultrasonography, and CT angiography. Four patients underwent duodenojejunostomy and one patient was managed with gastrojejunostomy. No complication was observed during the postoperative period, and all the patients achieved significant improvement in symptoms.Conclusion SMAS is a rare cause of UGS obstruction, and the diagnosis of SMAS is often delayed. SMAS should be suspected in the differential diagnosis of the patients with unsubstantiated symptoms of persistent nausea, emesis, and significant weight loss.

A Case of Superior Mesenteric Artery Syndrome

Case Report: A 31-year-old woman with celiac disease presented with onset of RUQ pain, which she had developed while on a field trip. Pain was sharp and constant with associated nausea but no vomiting. There was early satiety and unintended weight loss of 18 lbs. She was afebrile and her vitals were within normal range. There was tenderness on deep palpation in the RUQ. There was no guarding, rigidity or rebound tenderness. Laboratory evaluation revealed leukocytosis and anemia. Cross sectional imaging with contrast revealed significant narrowing of duodenum between aorta and SMA and compression of the transverse duodenum. EGD showed dilation of the duodenum. Small bowel series showed decreased flow in the duodenum across the midline. US showed the angle between duodenum and aorta to be 25 degrees. A diagnosis of SMA syndrome was made. Conservative management was successful in resolving her symptoms. She has not required surgical intervention to this point. Discussion: Superior mesenteric artery syndrome (SMAS) is an uncommon but well-recognized clinical entity. It is characterized by compression of third or transverse part of duodenum between aorta and superior mesenteric artery (SMA). The SMA usually forms an angle of 45 degrees between with the abdominal aorta and the third part of duodenum, which crosses caudal to the origin of the SMA. Any factor that narrows this angle can cause entrapment of transverse duodenum resulting in SMA syndrome. SMA syndrome may present acutely or with acute exacerbation of chronic symptoms. Symptoms can include epigastric pain, nausea, vomiting, postprandial discomfort, and early satiety. Symptoms are often aggravated when the patient is in supine position and relieved in the lateral decubitus, prone or kneechest positions. SMA syndrome may be suspected with clinical and radiographic findings suggestive of duodenal obstruction. Plain films may show dilated and fluid/gas filled stomach. Abdominal US may be helpful in measuring the angle between SMA and and aorta. Abdominal CT is also a useful diagnostic modality, providing aorta-SMA distance and evidence of duodenal distension. EGD may be required to exclude mechanical causes of duodenal obstruction. Conservative management is recommended for 4-6 weeks. This includes NG decompression, frequent small meals, and proper posturing (ie left lateral decubitus, prone, and knee chest position). Surgical intervention is indicated if these measures fail. Surgical options include bypass or derotation procedures. The outcome may be excellent with timely diagnosis and appropriate treatment.

G84(P) Superior mesenteric artery (SMA) syndrome: An unusual cause of proximal intestinal obstruction

BackgroundSMA Syndrome is characterised by a decreased acuity of the angle between aorta and SMA due to the loss of mesenteric fat between the SMA and aorta resulting in compression...

English

Superior mesenteric artery(SMA) syndrome is a very rare, life-threatening gastrovascular disorder characterised by compression of the third portion of the duodenum between the abdominal aorta (AA) and the overlying superior mesenteric artery. Recognition of SMA syndrome as a distinct clinical entity based on clinical examination and investigations is controversial. Looking at the rarity of the disease and very high mortality rate, the diagnosis of SMA syndrome should be kept in mind while treating any young patient with upper GI obstruction features. This case is being reported to emphasize the rare occurrence of SMA syndrome.

Superior Mesenteric Artery Syndrome Diagnosed with Linear Endoscopic Ultrasound (with Video) in a Patient with Normal Body Mass Index

Superior mesenteric artery (SMA) syndrome is an uncommon disease that results from SMA compression of the third portion of the duodenum. Patients with SMA syndrome present with upper gastrointestinal symptoms, such as nausea, vomiting, and abdominal pain. The diagnosis is usually made from an upper barium study or computed tomography. Typically, SMA syndrome is caused by a decreased aortomesenteric angle of 6° to 25°. An underweight body mass index (BMI) is a risk factor for development of SMA syndrome. There are few reports of the role of linear endoscopic ultrasound (EUS) in the diagnosis of SMA syndrome. We report a case of SMA syndrome, with normal BMI, that was diagnosed with the aid of linear EUS. Although SMA syndrome is not typically within the scope of practice of endosonographers, it is useful to get familiar with the findings.

An Uncommon Case of Abdominal Pain: Superior Mesenteric Artery Syndrome

Superior mesenteric artery (SMA) syndrome is a rare cause of abdominal pain, nausea and vomiting that may be undiagnosed in patients presenting to the emergency department (ED). We report a 54-year-old male presenting to a community ED with abdominal pain and the subsequent radiographic findings.The patient’s computed tomgraphy (CT) of the abdomen and pelvis demonstrates many of the hallmark findings consistent with SMA syndrome, including; compression of the duodenum between the abdominal aorta and superior mesenteric artery resulting in intestinal obstruction, dilation of the left renal vein, and gastric distension. Patients diagnosed with SMA syndrome have a characteristically short distance between the superior mesenteric artery and the aorta (usually 2–8 mm) in contrast to healthy patients (10–34 mm). Our patient’s aortomesenteric distance was measured to be approximately 4 mm. Furthermore, the measured angle between the superior mesenteric artery and the aorta is reduced in patients with SMA syndrome from a normal range of 28°–65° to a measurement between 6°–22°. Our patient’s aortomesenteric angle was difficult to measure secondary to poor sagittal reconstructions, but appears to be approximately 30°. Following radiographic evidence suggesting SMA syndrome together with our patient’s constellation of presenting symptoms, a diagnosis of SMA syndrome was made and the patient was admitted to the general surgery service. However, our patient decided to leave against medical advice owing to improvement of his symptoms following the emptying of two liters of gastric contents via nasogastric tube evacuation.

A Case of Superior Mesenteric Artery Syndrome Secondary to Surreptitious Laxative Abuse

Purpose: Superior mesenteric artery (SMA) syndrome is an uncommon and controversial entity which refers to compression of the third portion of the duodenum between the SMA and the aorta. This is typically due to loss of the intervening mesenteric fat pad from significant weight loss. Here, we present a case of a young woman who developed SMA syndrome after extensive weight loss from surreptitious laxative abuse. A 29 year old female with no significant past medical history was referred to Woman's and Infant's Hospital for evaluation of a one year history of abdominal pain, diarrhea and new onset weight loss. The patient had previously had a comprehensive workup which included multiple lab tests, upper and lower endoscopy, RUQ ultrasound, upper GI series with small bowel follow through, CT scan of abdomen and pelvis, hepatobiliary scan and ultimately, a diagnostic laparoscopy. Outside of a mildly elevated lipase, the patient had a completely normal workup. Upon presentation to our hospital, the patient was ill appearing and extremely cachectic with a BMI of 14. Outside records were obtained, and the patient provided the same history as previously reported. Additionally, the patient denied any current or previous use of laxatives. The patient underwent MR enterography upon admission which demonstrated a new proximal small bowel obstruction with a dilated stomach. Additionally, a laxative abuse screen was sent upon admission as well. A CT scan of the abdomen and pelvis was obtained to further evaluate the proximal small bowel and stomach. This too demonstrated the dilated small bowel and stomach with an approximate measurement of the angle between the SMA and aorta to be less than 10 degrees. This was consistent with a diagnosis of SMA syndrome. The patient ultimately underwent laproscopic duodenaljejunal bypass to alleviate the obstruction. One day after discharge, the patient's laxative abuse screen reported to be positive for bisacodyl in both her urine and feces. She continued to deny any current or previous laxative use.Figure

Superior mesenteric artery syndrome caused by celiac axis compression syndrome: a case report and review of the literature

Celiac axis compression syndrome (CACS) is a rare entity of mesenteric ischemia, secondary to inadequate blood supply to the intestine, resulting in weight loss because of postprandial abdominal pain. Superior mesenteric artery (SMA) syndrome is an uncommon cause of intestinal obstruction manifesting with epigastric pain, bilious vomiting, and postprandial discomfort. Although the coexistence of both syndromes is very rare and has been reported only in eight patients in the literature, the CACS as a rare etiology of SMA syndrome has not yet been reported. Herein, we describe an uncommon case of SMA syndrome secondary to the CACS. The 27-year-old woman presented with epigastric pain, postprandial vomiting, and rapid body weight loss. The diagnosis of SMA syndrome was made by hypotonic duodenography and multidetector computer tomographic angiography. The CACS was also suspected by multidetector computer tomographic angiography. Surgical intervention was performed and the presence of CACS was confirmed. Her symptoms subsided shortly after operation and she was in good health at 1-year follow-up.