Superior Mesenteric Artery Syndrome Research Articles

Superior mesenteric artery syndrome in a patient with rheumatoid arthritis and rheumatoid cachexia during the COVID-19 pandemic

Superior mesenteric artery syndrome in a patient with rheumatoid arthritis and rheumatoid cachexia during the COVID-19 pandemic

Superior Mesenteric Artery Syndrome in a Young Woman

Superior Mesenteric Artery Syndrome in a Young Woman

Superior Mesenteric Artery Syndrome With Acute Abdomen: A Case Report and Review of the Japanese Literature

Superior Mesenteric Artery Syndrome With Acute Abdomen: A Case Report and Review of the Japanese Literature

Measurement of the Angle Between the Superior Mesenteric Artery and the Aorta: Correlation with Body Mass Index

Objective: To discover the mean figures of the distance and angle between the superior mesenteric artery (SMA) and the aorta in four standard acknowledged body mass index (BMI) classifications in an ordinary populace and for the two genders, to work with a computed tomography CT based finding of Superior mesenteric artery syndrome (SMAS). Methods: A retrospective cross-sectional study was performed on 338 (157 female, 181 male) patients who were referred for abdominal CT examination. Age, sex, weight and height of all patients were noted, and the BMI was calculated. The distance between the SMA and aorta were measured, as was the angle. Pearson and Spearman correlation coefficients were used to correlate distance and BMI category, angle and BMI category, anteroposterior abdominal distance and SMA angle with aortomesenteric distance. Results: The mean BMI of patients in our study was 27.95 kg/m2 while the mean SMA angle, mean anteroposterior abdominal wall distance and mean aortomesenteric distance was 58.74 degrees, 224.35 cm, and 18.98 cm, respectively. The results showed positive correlation of BMI and anteroposterior abdominal distance with SMA angle and distance. This means if BMI increases, SMA angle and aortomesenteric distance will also increase, and vice versa. This same relationship was also valid for anteroposterior abdominal distance with aortomesenteric angle and distance. Conclusion: Our study helps in stating the values of aortomesenteric distance and angle for different BMI categories that can be used in CT-based diagnosis of SMAS in a South Asian population. The values we found for different BMI categories can be used by radiologists as a reference standard.

Gastric Necrosis Caused by Acute Gastric Dilatation due to Superior Mesenteric Artery Syndrome—Report of a Case—

Gastric Necrosis Caused by Acute Gastric Dilatation due to Superior Mesenteric Artery Syndrome—Report of a Case—

Two Cases of Superior Mesenteric Artery Syndrome after Y-Graft Replacement for Juxta-renal Abdominal Aortic Aneurysms

Two Cases of Superior Mesenteric Artery Syndrome after Y-Graft Replacement for Juxta-renal Abdominal Aortic Aneurysms

Syndrom arteria mesenterica superior v souvislosti s Crohnovou chorobou – kazuistika

Superior mesenteric artery syndrome (SMAS) is a rare condition characterized by mechanical compression of the third part of the duodenum between the abdominal aorta and the superior mesenteric artery. The relationship between Crohn‘s disease and SMAS is seldom described in literature, although patients with Crohn‘s disease have many predispositions to its development. We describe the case of a 17-year- -old female patient who has been dia gnosed with Crohn‘s disease for several years and has been experiencing symptoms of abdominal discomfort and significant weight loss for five months. Magnetic resonance imaging was a key method for dia gnosing SMAS. In addition, older contrast computed tomography scans were evaluated retrospectively with regards to the aortomesenteric angle and distance, the reduction of which is a diagnostic criterion for SMAS. Our goal is to highlight the importance of measuring these values in patients with Crohn‘s disease for early detection of the risk of SMAS.

The original modification of Albrecht – Staveley operation in the treatment of Wilkie’s syndrome

Abstract. Presents a clinical case of the treatment of a patient suffering from Wilkies syndrome. Wilkies syndrome (aorto-mesenteric compression of the duodenum) is a compression of the duodenum (its horizontal section) between the abdominal aorta and the superior mesenteric artery. The causes of this disease are asthenic constitutional type, sharp weight loss, etc. A natural complication of Wilkies syndrome is the occurrence of a chronic violation of duodenal patency. The method of choosing treatment for aorto-mesenteric compression is surgery. The most optimal volume of surgery is the formation of duodenojejunoanastomosis according to Albrecht Staveley, however, after this intervention, there is a high risk of a vicious circle syndrome. Patient M., 28 years old, who was scheduled for treatment, noted constant pain in the upper abdomen for 18 years, aggravated after eating, nausea, periodic vomiting, weakness. As a result of the examination, the patient revealed aorto-mesenteric compression of the duodenum. According to multispiral computed tomography of the abdominal organs with contrast at a distance of 40 mm from the mouth of the superior mesenteric artery, a horizontal branch of the duodenum is located between it and the aorta, its diameter at this level is no more than 4 mm, the angle of departure of the superior mesenteric artery from the aorta is 17 degrees. Violation of the passage through the duodenum was confirmed by fluoroscopy of the upper gastrointestinal tract with contrast. The patient underwent surgery. As a method of surgical treatment, an original modification of Albrecht Staveley operation was used, which, in addition to achieving the main goal, is aimed at preventing the development of the vicious circle syndrome. The patient was discharged from the clinic on the 10th postoperative day in satisfactory condition.

Manejo del Síndrome de Arteria Mesentérica Superior

El síndrome de arteria mesentérica superior o también llamado síndrome de Wilkie, consiste en un diagnóstico de exclusión, una condición que causa un cuadro de obstrucción intestinal alta de forma crónica usualmente debido a un acortamiento del ángulo aorto mesentérico y la distancia aortomesentérica. Su clínica se basa en vómitos postprandiales, llenura postprandial, pérdida de peso y suele acompañarse de condiciones adicionales que causan un franco adelgazamiento del paciente. Su valoración y manejo es multidisciplinario e involucra múltiples especialidades médicas y quirúrgicas. El manejo inicial es médico y nutricional y se basa en lograr un claro aumento de peso, sin embargo, muchas veces es fallido y el paciente requiere de cirugía. Cuando esto sucede la técnica ideal con menos morbilidad asociada y mayor resolución de sintomatología consiste en la duodeno yeyunostomía laparoscópica.

Wilkie's syndrome: a serendipitous diagnosis.

Wilkie's syndrome: a serendipitous diagnosis.

The risks, reasons, and costs for 30- and 90-day readmissions after fusion surgery for adolescent idiopathic scoliosis.

With the continued evolution of bundled payment plans, there has been a greater focus within orthopedic surgery on quality metrics up to 90 days of care. Although the Centers for Medicare and Medicaid Services does not currently penalize hospitals based on their pediatric readmission rates, it is important to understand the drivers for unplanned readmission to improve the quality of care and reduce costs. The National Readmission Database provides a nationally representative sample of all discharges from US hospitals and allows follow-up across hospitals up to 1 calendar year. Adolescents (age 10-18 years) who underwent idiopathic scoliosis surgery from 2012 to 2015 were included. Patients were separated into those with and those without readmission within 30 days or between 31 and 90 days. Demographics, operative conditions, hospital factors, and surgical outcomes were compared using the chi-square test and t-test. Independent predictors for readmissions were identified using stepwise multivariate logistic regression. A total of 30,677 patients underwent adolescent idiopathic scoliosis surgery from 2012 to 2015. The rates of 30- and 90-day readmissions were 2.9% and 1.4%, respectively. The mean costs associated with the index admission and 30- and 90-day readmissions were $60,680, $23,567, and $16,916, respectively. Common risk factors for readmissions included length of stay > 5 days, obesity, neurological disorders, and chronic use of antiplatelets or anticoagulants. The index admission complications associated with readmissions were unintended durotomy, syndrome of inappropriate antidiuretic hormone, and superior mesenteric artery syndrome. Hospital factors, discharge disposition, and operative conditions appeared to be less important for readmission risk. The top reasons for 30-day and 90-day readmissions were wound infection (34.7%) and implant complications (17.3%), respectively. Readmissions requiring a reoperation were significantly higher for those that occurred between 31 and 90 days after the index readmission. Readmission rates were low for both 30- and 90-day readmissions for adolescent idiopathic scoliosis surgery patients. Nevertheless, readmissions are costly and appear to be associated with potentially modifiable risk factors, although some risk factors remain potentially unavoidable.

EUS-guided gastroenterostomy for duodenal obstruction secondary to superior mesenteric artery syndrome.

EUS-guided gastroenterostomy for duodenal obstruction secondary to superior mesenteric artery syndrome.

Wilkie’s Weight Loss Wonder: A Case Series

INTRODUCTIONWilkie’s Syndrome, also known as Superior Mesenteric Artery Syndrome (SMAS), is a rare cause of bowel obstruction that can contribute to vague abdominal symptoms on clinical presentation. This syndrome occurs when the aortomesenteric angle decreases, compressing the third portion of the duodenum between the aorta and the superior mesenteric artery. An acute decrease in the mesenteric fat pad cushion between these two blood vessels is the primary etiology, although other causes (e.g., anatomical, postoperative, functional, and pubescent etiologies) have also been described.CASE PRESENTATIONIn the present cases, 2 females with a common history of recent weight loss presented to our institution with similar symptoms of abdominal pain, nausea and vomiting. Each patient was subsequently diagnosed with SMAS following imaging studies. Both patients experienced successful resolution of symptoms with conservative nutritional management.DISCUSSIONCommon presenting complaints of SMAS include nausea, vomiting, early satiety and postprandial pain. These symptoms overlap with other gastrointestinal disorders (i.e., mesenteric ischemia, intestinal volvulus, peptic ulcer disease) making diagnosis difficult. SMAS can be identified through imaging modalities including barium studies and computer tomography. First line therapies typically include conservative nutritional support and promotion of weight gain. If conservative therapies fail, various surgical procedures can be pursued. Delayed diagnosis can lead to further pathological sequelae, including duodenal compromise, ischemia and necrosis. As the syndrome progresses, success of conservative nutritional support is less likely, and surgical correction becomes increasingly necessary.CONCLUSIONTherefore, a clinical goal for SMAS should include as swift a recognition and diagnosis as possible.

Wilkie’s Syndrome Following Weight Loss in a Trauma Patient

Wilkie’s syndrome, or superior mesenteric artery syndrome, is a rare condition of duodenal obstruction caused by compression of the superior mesenteric artery on the third part of the duodenum. The diagnosis should be considered in a patient who has experienced significant weight loss and now presents with persistent vomiting, especially if the vomiting occurs with the patient in the supine position and is alleviated by the lateral or prone position. The diagnosis can be confirmed by imaging studies demonstrating compression of the third part of the duodenum, and the main aim of treatment should be to pass a feeding tube beyond the point of obstruction to allow enteral feeding. The condition improves spontaneously with weight gain. Further treatment options include parenteral feeding and operative bypass in select cases. Here we present a case of Wilkie’s syndrome in a trauma patient with significant weight loss, together with a review of the literature on this interesting topic.

Wilkie's syndrome in an adolescent female patient

<p>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.</p>

Laparoscopic duodenojejunostomy to manage small bowel obstruction due to superior mesenteric artery syndrome after Roux-en-Y gastric bypass.

Superior mesenteric artery (SMA) syndrome (Wilkie or cast syndrome) is a rare disease that was first described in 1842. It is seen in patients most often after dramatic weight loss due to starvation, burns, anorexia nervosa, or bariatric surgery.

S3593 Superior Mesenteric Artery Syndrome: A Rare Cause of Gastrointestinal Obstruction

INTRODUCTION: Superior mesenteric artery syndrome is an uncommon cause of proximal intestinal obstruction that occurs when the abdominal aorta and the superior mesenteric artery compress the distal part of the duodenum. It has been referred to by a variety of other names, including Cast Syndrome, Wilkie’s syndrome and duodenal vascular compression. Here we present the case of a 29-year-old female who was diagnosed with superior mesenteric artery syndrome refractory to conservative treatment. CASE DESCRIPTION/METHODS: The patient is a 29-year-old female with a medical history of generalized anxiety disorder and major depressive disorder who presented to the emergency department (ED) complaining of abdominal pain, nausea, and vomiting for 2 months. Abdominal pain was described as intermittent, sharp, located in the epigastric area, associated with nausea, non-bilious, non-bloody vomiting, bloating, and unintentional weight loss. On physical exam, the patient looked cachectic, with a tender abdomen. Initial workup was remarkable for hypokalemia and hypochloremia. Notable imaging included an abdominal X-ray showing a fluid-filled dilated stomach compatible with gastric outlet obstruction. A computed tomography (CT) scan of the abdomen and pelvis showed marked gastric dilatation with lesser dilatation of the first and second portion of the duodenum with narrowing or compression at the third and fourth portion and proximal jejunum. Additionally there was a decreased aorta mesenteric distance and angle, most likely compatible with a superior mesenteric artery (SMA) syndrome (Figure 1,2,3). The patient subsequently underwent esophagogastroduodenoscopy (EGD) that revealed copious amounts of retained bilious liquid and food material in the proximal stomach with no evidence of gastric outlet obstruction. There were no gross endoluminal lesions in the duodenum, but the sweep could not be traversed due to extrinsic compression likely secondary to SMA syndrome. The patient received adequate intravenous hydration and nasogastric tube (NGT) decompression with improvement of symptoms. After improvement of symptoms the patient left the hospital against medical advice and refused further evaluation. DISCUSSION: Superior mesenteric artery syndrome, although rare, should be considered as one of the differential diagnoses in the presence of partial or complete gastrointestinal obstruction. This can be successfully managed with conservatory measures, thus avoiding surgery which is reserved for refractory cases.Figure 1.: CT scan of the abdomen showing marked gastric dilation (blue arrows).Figure 2.: CT of the abdomen (axial view) showing decreased distance between the abdominal aorta (red arrow) and superior mesenteric artery (blue arrow) consistent with SMA syndrome.Figure 3.: CT of the abdomen (sagittal view) showing decreased distance between the abdominal aorta (red arrow) and superior mesenteric artery (blue arrow) consistent with SMA syndrome.

S2896 A Rare Case of Proximal Intestinal Obstruction from Superior Mesenteric Artery Syndrome

INTRODUCTION: Superior mesenteric artery (SMA) syndrome is a rare disorder that is characterized by compression of the third portion of the duodenum due to narrowing of the angle between the SMA and the aorta. Patients typically present with intermittent postprandial epigastric pain, nausea, and bilious vomiting. We report a case of a 25-year-old female who presents with symptoms of intestinal obstruction, diagnostic evaluation revealing SMA syndrome, and successful duodeno-jejunostomy procedure. CASE DESCRIPTION/METHODS: A 25-year-old female history of cholecystectomy presented with worsening symptoms of nausea, intractable vomiting, postprandial epigastric pain, and twenty pound weight loss for 2 years. She had multiple hospitalizations and extensive gastrointestinal work-up in the past without any identifiable cause of her symptoms. Physical exam, labs, CT abdomen and pelvis, EGD, colonoscopy, and PillCam endoscopy were benign. CT angiography of abdomen and pelvis demonstrated a decreased aorta-superior mesenteric artery angle of 9.1 degrees (normal 38 degrees to 65 degrees) with aorta- superior mesenteric distance of 5.1 mm (normal 10 to 28 mm), and compression of the third part of duodenum, confirming the diagnoses of SMA syndrome. She was initially managed conservatively with duodenal and gastric decompression via NG tube, fluid and electrolyte correction, body positioning, proton pump inhibitors, and nutritional support. Unfortunately, the patient had no improvement in her symptoms and subsequently required duodeno-jejunostomy. Upon completion of the procedure, the patient had complete resolution of her presenting symptoms. DISCUSSION: The diagnosis of SMA syndrome requires a high clinical suspicion in order to obtain abdominal angiography in patients with persistent symptoms despite negative endoscopic and conventional radiographic findings. Diagnosis requires an aorto-mesenteric angle between 6-22 degrees and an aorto-mesenteric distance between 2-8 mm on CT angiography. Patients should initially be managed with conservative therapy. However, if symptoms fail to improve or increase in severity, surgery is the definitive treatment. Surgical options include duodeno-jejunostomy, gastro-jejunostomy, and Strong’s procedure. Duodeno-jejunostomy is the procedure of choice, as it carries a 90% success rate.

S2886 Superior Mesenteric Artery Syndrome: Case Report and Review of Literature

INTRODUCTION: First reported by Rokitansky in 1861, Superior Mesenteric Artery (SMA) Syndrome is a rare medical condition occurring due to compression of third portion of duodenum between the SMA and abdominal aorta (AA).(1) It is often overlooked in medical practice. We describe the case of a 56-year-old F who had intermittent symptoms of nausea, vomiting and abdominal distention, who was found to have SMA syndrome. CASE DESCRIPTION/METHODS: A 56-year-old female was admitted to the hospital with abdominal distention, nausea, vomiting and fatigue. She had symptoms of abdominal distention and bloating for six years that required intermittent hospitalization and was managed conservatively with bowel rest and replenishment of electrolytes. She was cachectic with a BMI of 16 kg/m2. Abdomen was soft and distended with succession splash and normoactive bowel sounds. CT scan of the abdomen showed massively distended fluid filled stomach and narrow aortomesenteric angle (14°) (Figures 1A and 1B). EGD was performed which showed normal appearing patent pylorus and severe stenosis of the third portion of the duodenum with duodenal stenosis appearing to be secondary to extrinsic compression from the superior mesenteric artery (Figures 2A and 2B). She was started on small fractionated meals, low residue diet. Her hospital stay was complicated by sepsis, delirium and multiorgan failure. Due to her overall poor prognosis, she was discharged on hospice. DISCUSSION: The third portion of duodenum (D3) traverses in the area between the abdominal aorta and SMA at the level of L3 vertebra and is suspended at this location by the ligament of Treitz. This area decreases in people with rapid weight loss and cachexia. Symptoms include early satiety, bloating, nausea, intractable vomiting, acid reflux, weight loss, and post prandial upper abdominal pain. The diagnosis is confirmed by computerized tomogram (CT) angiogram of the abdomen demonstrating angle between the origin of the SMA and the AA to be < 22° and aortomesenteric distance less than 10 mm (normal 10–28 mm) (Figure 4). Conservative approach (gastric decompression and replenishment of fluids and electrolytes) is the first line strategy in management, followed by surgery (Duodenojejunostomy is gold standard).(2)Figure 1.: A- Normal appearing pylorus B- Compression of duodenum.Figure 2.: A- Distended stomach. B- narrow aortomesenteric angel and compression of duodenum.

S2768 A Rare Case of Small Intestinal Obstruction From Superior Mesenteric Artery Syndrome (SMAS) in Patient With Systemic Sclerosis (SS)

S2768 A Rare Case of Small Intestinal Obstruction From Superior Mesenteric Artery Syndrome (SMAS) in Patient With Systemic Sclerosis (SS)