Superior Mesenteric Artery Syndrome Research Articles

Applying A Hip Spica In A Child

Hip spica cast is a useful modality for the lower limb immobilization in children with hip and femur pathologies. Single, one and half, double limb spica cast may be applied depending on the indication. The position of hip immobilization is also dependent on the underlying pathology for which the spica is being applied. The inguinal region and knee are potential weak spots in a spica and these should reinforce during spica application. Potential complications include plaster sores, breakage, avascular necrosis of femoral head (in developmental dysplasia of hip), neurovascular compromise, and superior mesenteric artery syndrome (very rare). Careful attention to technique and vigilant after-care is necessary to prevent these complications.

Duodenojejunal Diamond-Shaped Anastomosis in Addition to Strong’s Procedure for Superior Mesenteric Artery Syndrome in a Child With Myotonic Dystrophy

Duodenojejunal Diamond-Shaped Anastomosis in Addition to Strong’s Procedure for Superior Mesenteric Artery Syndrome in a Child With Myotonic Dystrophy

A Case of Superior Mesenteric Artery Syndrome in a Young Patient Treated Laparoscopically with Double Tract Reconstruction

A Case of Superior Mesenteric Artery Syndrome in a Young Patient Treated Laparoscopically with Double Tract Reconstruction

A Case of Superior Mesenteric Artery Syndrome Developed after Surgery for Young-onset Descending Colon Cancer with Intussusception

A Case of Superior Mesenteric Artery Syndrome Developed after Surgery for Young-onset Descending Colon Cancer with Intussusception

Superior Mesenteric Artery Syndrome in an Adolescent with No Significant Weight Loss: A Case Report

This case report discusses a case of superior mesenteric artery (SMA) syndrome in a previously healthy 16-year-old male without significant weight loss or usual risk factors. This patient presented to the emergency department with 4 days of bilious vomiting and epigastric pain that started after ingestion of a large meal and intense exercise. During his illness he was seen at 3 different healthcare facilities before receiving a diagnosis at the fourth visit. SMA syndrome was initially suspected based on the location of obstruction on CT but was not confirmed until upper endoscopy was performed. In puberty, males have an increase in lean body mass with concurrent loss of adipose. With these changes, the angle between the aorta and the superior mesenteric artery can narrow with decrease in mesenteric fat.

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.

Superior Mesenteric Artery Syndrome

The patient was a 22-year-old woman with a 10-year history of anorexia nervosa restricting subtype who had been diagnosed with superior mesenteric artery (SMA) syndrome (Figure 1). She reported diffuse abdominal pain and nonvolitional vomiting shortly after food consumption, which was contributing to further weight loss. With nutritional rehabilitation, which initially included increased amounts of liquid supplements and eventual tolerance of a regular oral diet, she achieved a body mass index of 20.08 kg/m2, with near resolution of her gastrointestinal (GI) symptoms and computed tomography findings no longer meeting criteria for SMA syndrome (Figure 2).Figure 2After weight restoration (body mass index, 20.08 kg/m2; aortomesenteric distance, 4.72 mm; aortomesenteric distance, 8.05 mm). SMA = superior mesenteric artery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Superior mesenteric artery syndrome is a frequently overlooked cause of abdominal pain and emesis associated with food consumption in patients who have lost substantial weight. Superior mesenteric artery syndrome results from the compression of the horizontal duodenum between the SMA and the aorta owing to atrophy of the mesenteric fat pad resulting from weight loss. Diagnosis can be made functionally with upper GI series or with computed tomography angiography or magnetic resonance angiography; an aortomesenteric angle less than 25° or an aortomesenteric distance less than or equal to 8 mm are the most frequently cited diagnostic criteria.1Unal B. Aktaş A. Kemal G. et al.Superior mesenteric artery syndrome: CT and ultrasonography findings.Diagn Interv Radiol. 2005; 11: 90-95Google Scholar Patients may be referred for surgical intervention, but surgery should never be first-line treatment as duodenal compression and, hence, the GI symptoms resolve with even modest weight restoration and reconstitution of the mesenteric fat pad (see Figures 1 and 2).2Watters A. Gibson D. Dee E. Mascolo M. Mehler P.S. Superior mesenteric artery syndrome in severe anorexia nervosa: a case series.Clin Case Rep. 2019; 8: 185-189Google Scholar Options for nutritional rehabilitation can include increased liquid supplements, enteral nutrition bypassing the duodenal compression, or total parenteral nutrition in extreme cases. The patient was a 22-year-old woman with a 10-year history of anorexia nervosa restricting subtype who had been diagnosed with superior mesenteric artery (SMA) syndrome (Figure 1). She reported diffuse abdominal pain and nonvolitional vomiting shortly after food consumption, which was contributing to further weight loss. With nutritional rehabilitation, which initially included increased amounts of liquid supplements and eventual tolerance of a regular oral diet, she achieved a body mass index of 20.08 kg/m2, with near resolution of her gastrointestinal (GI) symptoms and computed tomography findings no longer meeting criteria for SMA syndrome (Figure 2). Superior mesenteric artery syndrome is a frequently overlooked cause of abdominal pain and emesis associated with food consumption in patients who have lost substantial weight. Superior mesenteric artery syndrome results from the compression of the horizontal duodenum between the SMA and the aorta owing to atrophy of the mesenteric fat pad resulting from weight loss. Diagnosis can be made functionally with upper GI series or with computed tomography angiography or magnetic resonance angiography; an aortomesenteric angle less than 25° or an aortomesenteric distance less than or equal to 8 mm are the most frequently cited diagnostic criteria.1Unal B. Aktaş A. Kemal G. et al.Superior mesenteric artery syndrome: CT and ultrasonography findings.Diagn Interv Radiol. 2005; 11: 90-95Google Scholar Patients may be referred for surgical intervention, but surgery should never be first-line treatment as duodenal compression and, hence, the GI symptoms resolve with even modest weight restoration and reconstitution of the mesenteric fat pad (see Figures 1 and 2).2Watters A. Gibson D. Dee E. Mascolo M. Mehler P.S. Superior mesenteric artery syndrome in severe anorexia nervosa: a case series.Clin Case Rep. 2019; 8: 185-189Google Scholar Options for nutritional rehabilitation can include increased liquid supplements, enteral nutrition bypassing the duodenal compression, or total parenteral nutrition in extreme cases. We thank Sara Nieder for her help in obtaining the images.

Postoperative superior mesenteric artery syndrome following appendicectomy: A case report.

IntroductionSuperior mesenteric artery syndrome is a rare cause of proximal intestinal obstruction. It is caused by a narrow aortomesenteric angle resulting in external compression of the duodenum as it traverses between the abdominal aorta and the superior mesenteric artery. Presenting symptoms tend to be non-specific and aetiological risk factors for this syndrome remain subjects to debate. The lack of awareness for this phenomenon often results in a delayed diagnosis, yet it can predispose to potentially life-threatening complications.Case presentationWe describe an acquired case of SMA syndrome, in an 88-year old male who underwent an open appendicectomy 20 years prior. The patient presented with an 18-month history of progressive anorexia, weight loss, and intractable vomiting. After inconclusive initial investigations, an exploratory laparotomy demonstrated extensive postoperative adhesions, placing traction on the SMA through its ileocolic branch, resulting in acute angulation of the SMA and subsequent external duodenal compression.DiscussionThis case illustrates the acute evolving presentation of gastric and duodenal obstruction associated with SMA syndrome, and the need to raise the index of suspicion for its diagnosis. In this case, it is postulated that SMA syndrome presented as a late complication of an open appendicectomy - A rare presentation for a rare disease.ConclusionSMA syndrome is an uncommon, but important differential for upper gastrointestinal obstruction. This case illustrates the challenges in the diagnosis of this rare clinical entity. Further study is warranted to understand the varied aetiology and optimal management for patients presenting with SMA syndrome.

Complications in adolescent idiopathic scoliosis surgery. Review

To days debates about most frequent complications after adolescent idiopathic surgery and its risk factors remains to persist. Taking into account rising possibilities of orthopaedic surgery departments worldwide to reduce AIS patients hospital length of stay, strong need in strict knowledge about types and frequency of abovementioned complications and its risk factors is emerging. This knowledge can help clinicians in prediction of complications development and can aid in better diagnostics and treatment. Two main groups of complications were described thoroughly in current review: non-neurologic and neurologic. Both frequently developing and rare complications were described including superior mesenteric artery syndrome and deep infections.&#x0D; There an obvious tendency of the rate of complications after AIS surgery to decline during last two decades from 5.7% in 20002003 to 4.95% in 2007 and to 0.98% in 2016. Despite that fact these complications still remain to be a big burden for clinicians. Major risk factors for its development include concomitant renal diseases, large intraoperative blood loss, substantial increase of anesthesia and surgery duration, stainless steel rods implementation combined or anterior only approach and refuse of intraoperative neuromonitoring.

Surgical treatment of abdominal compression syndromes: The significance of hypermobility-related disorders.

Case reports and systematic studies of the most common hypermobility-related disorders, hypermobile Ehlers-Danlos syndrome (hEDS), and hypermobility spectrum disorder (HSD) typically describe gastroenterological symptoms and complaints attributed to structural malfunction, autonomic dysfunction, or inflammation of the gastrointestinal tract. However, abdominal compression syndromes (CS) may also contribute to pain and dysfunction in these individuals and be the leading pathology given symptoms significantly reduce or cease after decompressive surgery. Arising not only in the abdomen and causing pain (median arcuate ligament syndrome [MALS] and superior mesenteric artery syndrome [SMAS]), CS also occur in the retroperitoneum and the pelvis (nutcracker syndrome and May-Thurner syndrome), these latter conditions causing chronic pelvic congestion syndrome (PCS). Here, we report primarily on our experience of the assessment and management of MALS and SMAS in a cohort of cases with a surprising prevalence of HSD and hEDS. To our knowledge, this is the first cohort report of its kind in hEDS, HSD, and CS. We recommend that CS are considered in hEDS and HSD individuals with gastrointestinal and other painful complaints within the "belt" area. These CS can be identified using functional ultrasound duplex examination in experienced hands, and in appropriate cases stabilizing surgery can substantially improve quality of life.

A CASE REPORT : A CASE OF SUPERIOR MESENTERIC ARTERY SYNDROME

Superior mesenteric artery (SMA) syndrome is an uncommon but well recognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum between the aorta and the superior mesenteric artery. This results in chronic, intermittent, or acute complete or partial duodenal obstruction. Superior mesenteric artery syndrome was rst described in 1861 by Von Rokitansky, who proposed that its cause was obstruction of the third part of the duodenum as a result of arterio-mesenteric compression. Some studies report the incidence of superior mesenteric artery syndrome to be 0.1- 0.3%.

70-Year-Old Man With Chronic Nausea and Vomiting

70-Year-Old Man With Chronic Nausea and Vomiting

A Model Example: Coexisting Superior Mesenteric Artery Syndrome and the Nutcracker Phenomenon

Aorto-mesenteric clamp syndrome or Wilkie's syndrome is a rare cause of upper intestinal obstruction resulting from compression of the third portion of the duodenum as it passes between the superior mesenteric artery and the aorta. Clinically, it is characterized by intermittent vomiting, nausea and abdominal pain related to the degree of duodenal compression. The diagnosis is based on abdominal computed tomography. Medical management with decompression using a nasogastric tube and adequate nutritional support are initially recommended. Surgical treatment is indicated in case of failure of conservative management.

TP7.2.15 Superior Mesenteric Artery Syndrome Managed with Laparoscopic Duodenojejunostomy: Case Series and Review of the Literature

Abstract Aims Superior Mesenteric Artery (SMA) Syndrome is a rare disorder which may be managed surgically when conservative management fails. We present a case series of six patients who underwent laparoscopic duodenojejunostomy in our tertiary centre for treatment of SMA Syndrome. The aim of our case series is to assess and present our outcomes in comparison to the limited available literature on the topic. Methods Retrospectively, we identified all patients who underwent laparoscopic duodenojejunostomy for SMA Syndrome in our tertiary university centre’s surgical database between December 2016 and July 2019. Data collected included demographics, presenting symptoms, co-morbidities, pre and post-operative Body Mass Index (BMI), operative approach, operative blood loss, operative duration, length of hospital stay, clinical and radiological results, in hospital/30 day complications, mortality and post operative follow up outcomes. Results We identified six patients, 1:5 male to female ratio, with a median age 18 years of age (range 17-31 years). All patients had refractory symptoms after a minimum of two months (range 2-5 months) of conservative management and subsequently underwent laparoscopic duodenojejunostomy. Median hospital stay was 7 days and no in hospital/30 day post operative mortality or complications were identified. Follow up data showed no recurrence of symptoms and a BMI median increase of 10.2 (range 8-13.6) at a median follow-up of 18 months (range 12-30 months) Conclusions 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 causing gastric outlet obstruction: A myth in acute abdomen

Objective: We aim to report a case of gastric outlet obstruction in adolescence that was diagnosed as a superior mesenteric artery syndrome and treated successfully by gastrojejunostomy. Case report: A 17-year-old female presented to emergency department with acute abdomen. She was also complaint of significant weight loss past 2 months. On clinical examination she was underweight with fullness of upper abdomen down to umbilicus. Oesophagogastroduodenoscopy (OGDS) was performed showed grossly dilated stomach with unable to go beyond D3 region. Contrast Enhanced Computed Tomography (CECT) abdomen suggestive of Superior Mesentery Artery (SMA) syndrome. She was subjected to gastrojejunostomy and recovered well postoperatively. Conclusion: An acute onset of gastric outlet obstruction in adolescence can be a diagnostic and treatment challenging. Our case patient was diagnosed as a SMA syndrome based on the history taking and CT findings. We would like to advocate a high index of suspicious SMA syndrome should be included in an acute abdomen in adolescence besides volvulus and malrotation. The treatment options should be individualized. In this case we opted for a gastrojejunostomy compared to duodenojejunostomy. The decision was made based on the patient nutritional status as patient was low Body Mass Index (BMI) was 16 kg/m2 which carries a high risk of anastomotic leak. Keywords: superior mesenteric artery syndrome; cast syndrome; wilkie’s syndrome; arteriomesenteric duodenal compression; duodenal vascular compression.

Role of Laparoscopy in the Surgical Management of Acute Small Bowel Obstruction: Fact or Fiction?

Background: Laparotomy (open surgery) is considered the standard approach for acute small bowel obstruction (ASBO). However, with the advent of minimally invasive surgery, the laparoscopic approach is gaining popularity. There is no consensus on the appropriate setting for laparoscopic therapy for small bowel obstruction (SBO).Aim and objectives: The purpose of this study is to evaluate the outcomes of laparoscopic surgery for ASBO.Patients and methods: We retrospectively evaluated the prospectively collected data of all the 38 patients who had undergone laparoscopy for ASBO, performed by a single surgeon at our institution, due to adhesions (30 patients), internal hernias (five patients), midgut malrotation (one patient), ileo-ileal intussusception (one patient), and superior mesenteric artery (SMA) syndrome (one patient) from 2012 to 2020. Data were extracted from the hospital electronic medical records (EMR) for the following parameters of each individual patient: age, sex, clinical presentation, preoperative investigation findings, final diagnosis, surgical details, operating time, time to postoperative oral feeds, length of hospital stay, complications, recurrences, and time taken to resume normal activity. A preoperative abdominal contrast-enhanced computed tomography (CECT) was performed in all the cases. Patients with peritonitis and septic shock were excluded from the study. Results: The mean age of the 38 patients was 58 years (ranged between 33 and 83 years) with a standard deviation (SD) of 16.5. The mean age of the female patients in the study was 60.5 years with an SD of 16.6, while the mean age of the male patients was 54.9 years (SD = 16.2). The age difference between male and female patients in the study was not statistically significant (p = 0.36). The mean operating time was 74.4 minutes (range: 60-90 minutes, with an SD of 7.2). The mean time to oral liquid/soft diet was 2.5 days. The mean postoperative stay was 5.7 days. Three patients (8%) underwent conversion to open surgery, out of which two patients had multiple complex bowel-to-bowel and bowel-to-parietes adhesions, and in one patient, massive distension of small bowel caused technical difficulties.Conclusion: Laparoscopic management of ASBO is feasible, effective, and safe. Optimum surgical techniques, the surgeon's experience with the procedure, and stringent patient selection criteria enable a high probability of success.

Intraoperative Endoscopy as an Adjuvant to Minimally Invasive Surgery in Pediatrics.

Background: Minimally invasive surgery has a different visual and tactile perception compared with conventional surgery, which could lead to complications, especially in complex procedures. In these cases, flexible endoscopy can facilitate and prevent complications in minimally invasive procedures in children. The study aimed to clarify the utility of intraoperative endoscopy as an adjuvant to minimally invasive surgery in children. Materials and Methods: This retrospective study reviewed the medical records of pediatric patients who had undergone endoscopy during a minimally invasive surgery to treat an upper digestive pathology between January 2000 and December 2020. Results: The study included 83 patients who underwent a laparoscopic procedure with simultaneous endoscopy. The diagnosis was peptic stenosis in 9 patients, achalasia in 23, congenital embryonic tracheobronchial remnants in 4, re-fundoplication in 42, esophageal duplication in 2, superior mesenteric artery syndrome in 2, and giant gastric hemangioma in 1 patient. With adjuvant endoscopy, 7 digestive perforations were noted, 11 cases of short esophagus were diagnosed, and the permeability of the anastomosis was confirmed in 6 cases. No complications were related with the endoscopy procedures. Discussion: Minimally invasive surgery has a few special and tactile limitations that can lead to complications in certain procedures. Simultaneous digestive endoscopy in the upper gastrointestinal tract facilitates organ identification and dissection. Conclusion: Digestive endoscopy is an excellent adjunct to minimally invasive surgery in children because it facilitates and identifies complications and ensures safer minimally invasive surgeries. Future prospective studies are required to assess this conclusion.

S2950 The Gutcracker: A Case of Superior Mesenteric Artery Syndrome

Introduction: Superior Mesenteric Artery (SMA) Syndrome is estimated to effect 0.1-0.3% of the population and is not only a rare disease of exclusion but can be detrimental and debilitating making it challenging to treat. We describe a case of a patient with newly diagnosed SMA syndrome. Case Description/Methods: A 66-year-old male with a past medical history significant for congestive heart failure and Barrett’s esophagus presented with acute on chronic atypical chest pain and epigastric pain that has progressively worsened over three days. He described it as most severe after eating and felt that his entire chest and abdomen “was about to explode.” He reported decreased oral intake over the past 15 years due to the same chronic post-prandial epigastric pain. He reported a weight loss of 40-50 lbs. over the last year. He reported severe fatigue and has had trouble taking care of himself. The patient explained living in severe poverty without much of a support system. He also had nausea and decreased appetite with frequent belching. He was a cachectic appearing male with diffuse abdominal tenderness. A CT of the abdomen and pelvis was performed which demonstrated significant narrowing of the third portion of the duodenum at the level of SMA. Once a cardiac etiology of the pain was ruled out, an EGD was performed which discovered a significant amount of several days’ worth of undigested food content in the duodenum with duodenal narrowing. Since the CT and EGD findings were supportive of SMA syndrome, Surgery was consulted for potential surgical options. Surgery recommended an upper GI series to assess the motility and the patient was found to have transient vertical compression of the duodenum and delayed duodenal transit, confirming SMA syndrome. Discussion: Establishing the therapeutic approach was challenging as the patient was too frail to improve his diet on his own and too malnourished for surgical consideration. Conservative therapy with nutritional support was initiated and a multidisciplinary approach involving nutrition, speech pathology, and psychiatry was essential. Surgical management remained a potential option should conservative therapy fail. Due to his nausea, low appetite, and pain, he was started on TPN for further nutritional support. The case illustrates the complexity of SMA syndrome and the importance of a multidisciplinary approach to optimize treatment options and support the mental and physical wellbeing of the patient.Figure 1.: Upper GI Series revealing transient vertical compression of the duodenum and delayed duodenal transit consistent with SMA syndrome.

Superior mesenteric artery syndrome

Objectives:To determine the prevalence of superior mesenteric artery (SMA) syndrome in patients presenting with abdominal pains, and to evaluate computed tomographic (CT) findings needed for its diagnosis.Methods:This retrospective record-based study was carried out at the radiology department, from January 2016 to January 2021. All young patients (aged under 25) who underwent CT scans for abdominal pains were reviewed. Post-surgery, tumor, and trauma cases were excluded. Imaging findings for SMA syndrome were recorded as ‘suggestive’ (reduced aortomesenteric angle and distance with proximal duodenal dilatation), ‘possible’ (reduced angle and distance without proximal duodenal dilatation) and ‘probable’ (reduction of either angle or distance). Two radiologists interpreted the findings and consensus reporting was made. Diagnoses were confirmed on clinical grounds (symptomatic improvement by specific treatment and exclusion of other diagnoses), or barium studies. Imaging findings were compared to final diagnoses. McNemar’s Chi-square test was used to determine association.Results:Out of 141 patients (mean age=10.8, standard deviation=4), 7 (4.9%) patients mostly females were having SMA syndromes based on ‘suggestive’ imaging criteria (p=0.0005), and one patient underwent surgery.Conclusion:Superior mesenteric artery syndrome is not an uncommon condition and should be considered in differential diagnosis of acute abdomen in young patients after excluding other diagnoses.

S3699 Superior Mesenteric Artery Syndrome, Rare Yet Overlooked Diagnosis

Introduction: Superior mesenteric artery syndrome or Wilkie’s syndrome, an upper gastrointestinal disorder due to compression of the duodenum is rare yet a difficult diagnostic challenge. The pathophysiology entails the loss of the fat pad between the superior mesenteric artery and abdominal aorta, as a result of a variety of debilitating conditions. Case Description/Methods: 39-year-old white white female with a past medical history significant for an ischemic stroke and surgical history of hysterectomy presents with a chief complaint of localized, acute abdominal pain in the epigastric area, associated with nausea and vomiting, poor oral intake, leading to 10 lbs of weight loss, over two days before the current presentation. At admission, laboratory data were unremarkable. A right upper quadrant ultrasound ruled out biliary obstruction. However, a Computed Tomography(CT) of the abdomen and pelvis showed distended stomach and proximal duodenum concerning gastric outlet obstruction. A follow-up Upper GI series showed delayed transit at the level of the third portion of the duodenum, with a focal narrowing corresponding to findings on CT imaging which may represent SMA syndrome. An upper endoscopy was unrevealing with mild antral erythema, biopsies were unremarkable. Further imaging Magnetic Resonance angiogram, confirmed SMA syndrome described as decreased aortomesenteric angle and aortomesenteric distance between the aorta and SMA, resulting in compression of the third part of the duodenum. No surgical consultation requested, and conservative management with dietary modification and education on nutrition, patient symptoms improved gradually throughout the hospital stay. Discussion: SMA syndrome was first described by von Rokitanski in 1861. The incidence of this condition varies from 0.013-0.3% of the barium series of the upper GI tract. Normal imaging anatomy with aorto-mesenteric angle and aorto-mesenteric distance measures as 25°- 60° and 10 to 28 mm respectively. Both parameters are reduced in SMA, with values of 6° to 15° and 2 to 8 mm respectively. The diagnosis of SMAS is based mostly on clinical symptoms and radiologic evidence of obstruction by Barium studies, CT scan, and MR angiogram. Treatment options include dietary modification with an intent to gain lost weight. Medical management may be successful in some patients with a shorter duration of symptoms, however many patients need surgical correction.