Superior Mesenteric Artery Syndrome Research Articles

Paediatric Spinal Deformity Surgery: Complications and Their Management.

Surgical correction of paediatric spinal deformity is associated with risks, adverse events, and complications that must be preoperatively discussed with patients and their families to inform treatment decisions, expectations, and long-term outcomes. The incidence of complications varies in relation to the underlying aetiology of spinal deformity and surgical procedure. Intraoperative complications include bleeding, neurological injury, and those related to positioning. Postoperative complications include persistent pain, surgical site infection, venous thromboembolism, pulmonary complications, superior mesenteric artery syndrome, and also pseudarthrosis and implant failure, proximal junctional kyphosis, crankshaft phenomenon, and adding-on deformity, which may necessitate revision surgery. Interventions included in enhanced recovery after surgery protocols may reduce the incidence of complications. Complications must be diagnosed, investigated and managed expeditiously to prevent further deterioration and to ensure optimal outcomes. This review summarises the complications associated with paediatric spinal deformity surgery and their management.

Superior mesenteric artery syndrome identified following bubble tea ingestion and duodenal impaction: a case report.

Superior mesenteric artery syndrome identified following bubble tea ingestion and duodenal impaction: a case report.

S68 Concurrent Esophageal Crohn’s Disease and Superior Mesenteric Artery Syndrome in a Pediatric Patient

Case: A previously healthy 12-year-old female with 4-month history of malaise, dizziness, headaches, anorexia (20-pound weight loss). A month prior, she developed daily non-bilious, non-bloody emesis and early satiety. Denied abdominal pain, diarrhea, hematochezia, constipation, oral ulcers, rash or fever. Family history was negative for gastrointestinal illness. Physical exam showed thin stature, epigastric tenderness, weight 37.7 kg (27th percentile) and BMI 14.36 kg/m2 (2nd percentile). Initial labs: Hgb 13 g/dL, MCV 74.4 fL, albumin 2.5 g/dL, platelet 497,000/uL, CRP 16.6 mg/L, ESR 24 mm/hr and fecal calprotectin 2500 mcg/g with remainder unremarkable. Upper GI demonstrated mucosal irregularity/fold thickening and narrowing at the third portion of the duodenum. Superior mesenteric artery (SMA) ultrasound showed aortomesenteric angle EGD revealed esophagitis, gastritis and bulbar duodenitis. She received intravenous pantoprazole and NJ tube placed for enteral nutrition. Biopsy with chronic lymphocytic esophagitis, chronic active gastritis negative for Helicobacter Pylori or CMV, and chronic peptic duodenitis. MRE demonstrated a 1-2 cm segment of bowel wall thickening and hyperenhancement 10-20 cm proximal to the terminal ileum. Colonoscopy found terminal ileitis, unremarkable colon, and perianal disease consisting of a skin tag with small fissure. Biopsies revealed mixed inflammatory infiltrate consistent with chronic active ileitis. Discharged with NJ feeds for 4-6 weeks, and pantoprazole. Given first dose of adalimumab prior to discharge. Introduction: SMA syndrome is characterized by compression of the third portion of the duodenum between the SMA and the aorta. In pediatrics, the major cause is rapid weight loss leading to loss of the intervening mesenteric fat pad. Symptoms include postprandial epigastric pain and early satiety. Those with advanced obstructions may have severe nausea, bilious emesis and weight loss. The incidence ranges between 0.013 and 0.3%. Treatment is typically successful with enteral nutrition, with surgical intervention reserved for patient’s refractory to refeeding. Crohn’s disease (CD) is a chronic inflammatory disease that can affect any part of the GI tract. CD of the esophagus is less common, affecting 7.6-17.6% of pediatric patients. Most cases of esophageal CD present with symptoms similar to gastroesophageal reflux disease (GERD) with chest pain, heartburn and regurgitation and more advanced cases with odynophagia, vomiting, and weight loss. The mean time to diagnosis of CD and esophageal involvement is up to 3 years. Upper GI involvement of CD is more common in pediatric than adult population, but still less prevalent than lower GI involvement. Discussion: This is an atypical case of CD primarily involving the esophagus that led to the development of SMA syndrome. Though weight loss due to CD is common (57%) there is limited literature describing CD associated with SMA syndrome and only a few reported cases of SMA syndrome as the presenting sign of CD with nonspecific symptoms (vomiting, abdominal pain). There is an even smaller number of cases reported in the pediatric literature. Thus, it is important to highlight that esophageal CD, often presenting with nonspecific symptoms (vomiting, weight loss), is severe and can lead to SMA syndrome.

Intestinal neuronal dysplasia type B of the duodenum in an adolescent patient

Intestinal neuronal dysplasia type B (IND-B) is a rare neuromuscular, dysmotility disorder that typically affects the lower gastrointestinal tract, commonly presenting as chronic constipation in children. We present the first pediatric case report of successful surgical management of IND-B affecting the duodenum as a likely chronic adaptive sequela to prior obstruction from superior mesenteric artery syndrome.

Superior Mesenteric Artery Syndrome.

We report a unique case of obstruction of the upper gastrointestinal tract diagnosed in a 15-year boy presenting with a 6-month history of persistent abdominal pain, epigastric fullness, repeated episodes of vomiting, and significant weight loss. The computed tomography (CT) scan of the abdomen with intravenous and oral contrast demonstrated the angle between the aorta and superior mesenteric artery (SMA) to be 15° and revealed the stomach and duodenum to be massively dilated, leading up to a diagnosis of SMA syndrome, which was successfully operated. SMA syndrome is a challenging diagnosis and must always be included in the list of probable diagnoses causing obstruction of the upper gastrointestinal tract. Key Words: Upper gastrointestinal obstruction, Superior mesenteric artery syndrome, Small bowel obstruction, Duodenojejunostomy.

Superior Mesenteric Artery Syndrome

Superior mesenteric artery (SMA) syndrome is a rare clinical disease. We present a case of a 15-year-old girl with complaints of vomiting and epigastric pain during on admission. Her general appearance was tall and thin. She had the upper gastrointestinal (UGI) barium study, angiography and abdominal sonography performed to confirm the diagnosis of SMA syndrome. She received medical treatment and was discharged after the symptoms were relieved. Her followup had a smooth course in our out-patient department.

Superior mesenteric artery syndrome in a patient with esophageal stenosis: A case report

Superior mesenteric artery syndrome in a patient with esophageal stenosis: A case report

SMA Syndrome – Wait & Nurture

Superior mesenteric artery (SMA) syndrome is rare with the common presentation of megaduodenum from entrapment of the third part of the duodenum (D3) by the SMA. We present a case report of a thin, fit 16-year-old boy, active smoker complaining of generalized colicky abdominal pain associated with persistent postprandial vomiting. Small bowel study demonstrated partial duodenal obstruction from compression of the third part of the duodenum by the SMA. Computed tomography of the abdomen shows an aorto-mesenteric angle of 13 degrees with aorto-mesenteric distance of 0.32 cm, indicating SMA syndrome. His symptoms resolved spontaneously with watchful waiting and nutritional care plan. The success was contributed to restoring the fat cushion around the SMA, hence, widening the aorto-mesenteric angle. In conclusion, watchful waiting with a nutritional care plan is a feasible initial strategy in the approach to SMA syndrome. However, should this strategy be unsuccessful, the choice of surgical treatment is duodenojejunostomy.

Gastric dilatation in patients with restrictive eating disorders.

To better understand gastric dimensions in patients diagnosed with restrictive eating disorders (EDs). In this retrospective study, 56 patients, with restrictive EDs, and 60 gender/age/race-matched patients from an outpatient clinic, were studied. Difference in stomach size, between cohorts, was ascertained, and regression analyses were used to examine associations with stomach size in the ED cohort. Patients with EDs were found to have significantly enlarged gastric dimensions when compared to the control group (M:14.8cm [SD: 3.2] vs. 11.4cm [SD: 2.9], p< .0001). Among the ED cohort, blood urea nitrogen (BUN), on the day of imaging, positively correlated with gastric dimensions (r= .43, p= .0009), while hypoalbuminemia negatively correlated with gastric dimensions (r= -.37, p= .005). BUN and albumin nadir were also significantly associated with stomach size (r2 = .26, F[2,53]=9.46, p= .0003). There was no significant correlation between gastric dimensions and ED diagnosis, percent ideal body weight, gender, duration of illness, engagement in vomiting behaviors, diagnosis of superior mesenteric artery syndrome, or use of promotility agents. Findings in this study suggest that malnutrition, secondary to EDs, may be associated with an enlarged stomach. The relationship between the gastric dimensions and reported GI symptoms in this population remain to be determined. There are many physiologic changes to the gastrointestinal system that develop with malnutrition but the contribution of these physiologic changes toward the reported GI symptoms and refeeding difficulties is unclear. This is the first study to suggest that patients with malnutrition, secondary to EDs, may be associated with an enlarged stomach, and this potential relationship requires further investigation.

Wilke's Syndrome

Background: Superior mesenteric artery (SMA) syndrome or Wilke's syndrome is a rare, atypical cause of upper gastrointestinal tract obstruction. It occurs due to acute angulation between SMA and aorta causing compression of the third part of the duodenum inbetween them leading to proximal intestinal obstruction. Clinical Description: SMA syndrome occurs mostly in patients who have significant weight loss. It occurs mostly due to the loss of the retroperitoneal fat pad, which serves as a cushion for the duodenum protecting it from compression between the two arteries. Causes include prolonged supine bed rest, spine surgery, an unusual high insertion of ligament of Treitz, other causes leading to weight loss, and congenital anatomical defects. Symptoms include weight loss, bilious vomiting, pain abdomen, postprandial nausea, early satiety, and anorexia. We report a 14-year-old female, a known case of pulmonary tuberculosis, who developed pneumothorax followed by acute gastric dilatation superadded with septicemia and upper gastrointestinal tract obstructive symptoms during the hospital course. Management: Detailed history and radio imaging such as barium studies or contrast-enhanced computerized tomography abdomen are required for diagnosis. Treatment includes conservative management such as gastric decompression, maintenance of electrolytes, nutritional rehabilitation via nasojejunal feeding, orally or parenterally. Treatment aims to restore the mesenteric fat pad to increases the angle between the two arteries. If it fails, surgery needs to be planned wherein duodenojejunostomy can be performed. Conclusion: An increased index of suspicion should be kept for this rare syndrome in children, especially in cases associated with significant weight loss. This may lead to timely diagnosis and saving a precious life.

S3394 CT of a Greyhound? A Case of Superior Mesenteric Artery Syndrome

S3394 CT of a Greyhound? A Case of Superior Mesenteric Artery Syndrome

An Underrated Diagnosis of Superior Mesenteric Artery Syndrome: A Case Report.

Superior mesenteric artery syndrome (Wilkie’s syndrome) is a rare cause of intestinal obstruction caused by a congenital or acquired reduction of the aorto-mesenteric angle leading to duodenal compression. We present the case of a 51-year-old female patient with a previous history of breast cancer. She was admitted to the Emergency Department with acute onset of recurrent vomiting, intense abdominal pain especially in the epigastric region, and abdominal distension. The ultrasound showed an absence of lower abdominal quadrants with an enlarged and distended stomach reaching the pelvis. The computer tomography scans confirmed the diagnosis of superior mesenteric artery syndrome. Conservative management was implemented, and using a nasogastric tube, and upped endoscopy approximately 4000 mL of fluid were aspirated with clinical improvement shortly after. The patient resumed a high-calorie diet and five months later, the patient was completely asymptomatic.

Megaesophagus secondary to Wilkie syndrome

Megaesophagus secondary to Wilkie syndrome

Laparoscopic gastrojejunostomy with laparoscopic-assisted percutaneous endoscopic gastrostomy for superior mesenteric artery syndrome with dysphagia: a case report

BackgroundSuperior mesenteric artery (SMA) syndrome denotes a mechanical duodenal obstruction between the SMA and aorta. Total parenteral or enteral nutrition is the treatment of choice. However, surgical intervention is indicated if the patient’s condition does not improve with conservative treatment. Here, we describe a case of SMA syndrome with dysphagia treated by laparoscopic gastrojejunostomy with laparoscopic-assisted percutaneous endoscopic gastrostomy.Case presentationA 64-year-old man was admitted to another hospital because of appetite loss and vomiting. There, he was diagnosed as having superior mesenteric artery (SMA) syndrome after appropriate investigation. He had had a cerebral infarction at age 57 years, since which he had lived in social housing because of complications of that infarction. A nasogastric tube was inserted into the third portion of the duodenum beyond the constricted section. He was discharged 2 months after admission his condition having improved. He was subsequently referred to our hospital for gastrostomy because the nasogastric tube had been in place for a long time and his condition had not improved. Additionally, gastrostomy was needed as a route for enteral nutrition because he had dysphagia, which had persisted despite attempts at rehabilitation, restricting his food intake to small amounts. Computed tomography (CT) revealed compression of the third portion of the duodenum between the SMA and aorta. After obtaining informed consent, we planned an operative procedure. We performed laparoscopic gastrojejunostomy under general anesthesia, followed by laparoscopic-assisted percutaneous endoscopic gastrostomy. The operation time was 156 min and there was little blood loss. Contrast radiography on postoperative day 3 revealed no evidence of leakage or stenosis. Enteral nutrition via the gastrostomy was started. He was discharged from our hospital on the 27th postoperative day. The gastrostomy was well tolerated and there has been no evidence of recurrence of SMA syndrome during follow-up.ConclusionGastrostomy is often performed to provide a route for administering enteral nutrition in patients with dysphagia. Development of SMA syndrome in patients with dysphagia necessitates operative management of the obstruction. Here, we describe a case of SMA syndrome with dysphagia treated by laparoscopic gastrojejunostomy with laparoscopic-assisted percutaneous endoscopic gastrostomy.

Superior mesenteric artery syndrome secondary to thyrotoxicosis

Superior mesenteric artery (SMA) syndrome is defined as a narrowed space and decreased angle between the SMA and aorta leading to partial or complete obstruction of the third portion of the duodenum. SMA syndrome patients may have comorbid conditions associated with extreme weight loss, hypermetabolism or malnutrition. We present the case of a 55-year-old male with SMA syndrome due to acute weight loss secondary to thyrotoxicosis. The patient was nutritionally optimized and euthyroid prior to undergoing a robotic-assisted duodenojejunostomy. In this patient, the thyrotoxicosis was controlled medically, and he remained euthyroid postoperatively. His duodenal obstruction was relieved by the operation and he continued to gain weight appropriately.

Superior Mesenteric Artery Syndrome or Wilkie’s Syndrome: About a Case Report and a Review of the Literature

Superior mesenteric artery syndrome (SMA syndrome), also known as Wilkie's syndrome is a rare vascular disease due to extrinsic compression of the third portion of the duodenum between the superior mesenteric artery and the aorta. The symptoms are variable and non-specific, the treatment is first of all medical and surgery is reserved for unresponsive cases to medical treatment. We report a case of Superior mesenteric artery syndrome occurring in a 21- year-old patient, revealed by chronic epigastric pain with vomiting, the diagnosis is made by CT scan and the patient underwent laparoscopic gastro-entero-anastomosis, with good postoperative evolution.

Cross-sectional Imaging of the Duodenum: Spectrum of Disease.

Cross-sectional Imaging of the Duodenum: Spectrum of Disease.

Superior Mesenteric Artery Syndrome Managed with Laparoscopic Duodenojejunostomy.

Background Superior mesenteric artery (SMA) syndrome is a rare disorder that may be managed surgically if conservative management fails. Different surgical techniques have been described, division of the ligament of Treitz, gastrojejunostomy, and duodenojejunostomy. The aim of this case series is to show that laparoscopic duodenojejunostomy is a safe and technically feasible management for superior mesenteric artery syndrome. Methods In this case series, we retrospectively identified all patients who underwent laparoscopic duodenojejunostomy for SMA syndrome in our tertiary university center between December 2016 and July 2019. Data collected included demographics, presenting symptoms, comorbidities, pre and postoperative body mass index (BMI), operative approach, operative blood loss, operative duration, clinical and radiological results, in hospital/30-day complications, mortality, and postoperative follow-up outcomes. Results We identified eleven patients, 10 females and 1 male, with a median age 23 years (range 17–43 years). All patients had refractory symptoms after a minimum of two months of conservative management and subsequently underwent laparoscopic duodenojejunostomy. There were no intraoperative complications and no in-hospital or 30-day postoperative mortality or complications were identified. Follow-up data showed complete resolution in 73% of patients (n = 8) and only one patient with no improvement postoperatively. Results also showed a median BMI increase of 2 kg/m2 (range 1–9 kg/m2) at a median follow-up of 16 months (range 4–48 months). Conclusion Laparoscopic duodenojejunostomy is a safe treatment option for SMA syndrome and should be considered when patients do not respond to conservative management.

Superior Mesenteric Artery Syndrome: Late Complication of Ileal Pouch-Anal Anastomosis

Superior mesenteric artery syndrome (SMAS) is an uncommon condition which is difficult to diagnose due to non-specificity of symptoms. The most common causes of SMAS are severe weight loss secondary to severe medical conditions, surgical history, and cancer. A 31-year-old male with a history of ulcerative colitis status-post proctocolectomy with ileal pouch-anal anastomosis 10 years prior, presented with progressively worsening weight loss and abdominal pain. Radiographic imaging was consistent with SMAS, which was subsequently confirmed intraoperatively during an emergency surgery in which a Roux-En-Y gastrojejunostomy was performed. Clinicians should be aware that SMAS is a rare but possible complication of ileal pouch-anal anastomosis. Although rare, there should be a low threshold for this diagnosis when obstructive symptoms present.

SMA Syndrome – A Case Report and Review of Literature

Superior mesenteric artery (SMA) syndrome (Wiklie’s syndrome) is one of the rare causes of small bowel obstruction. It’s exact incidence is not known. It is due to decrease in aorto-mesenteric angle with resultant duodenal obstruction. Management is usually conservative but failure of conservative measures warrants surgical intervention. We present a case of 39 year old lady presented with SMA syndrome managed surgically.