Superior Mesenteric Artery Syndrome Research Articles

Superior mesenteric artery syndrome misdiagnosed and preceded by helicobacter pylori-induced gastritis: a rare diagnosis with misleading features

Introduction and Importance: Superior mesenteric artery syndrome is a rare morbid vascular disorder that is defined as the decreasing in the aortomesenteric angle and the compression of the third part of the duodenum. This disorder mainly affects young adult females, and severe weight loss represents a leading predisposing factor. Case presentation: We report the case of a 19-year-old male who was admitted to our hospital with a three-months history of epigastric pain, nausea, and weight loss. Two months earlier, the patient was diagnosed with helicobacter pylori-induced gastritis. Nevertheless, with complaints of severe headache and epigastric pain, the patient was admitted to our hospital for further investigations. Computed tomography scan with intravenous contrast injection was performed, and interestingly, the aortomesenteric angle was 19 degrees accompanied by a compression of the third part of the duodenum, and a mild gastric dilatation. Accordingly, the diagnosis was confirmed as a superior mesenteric artery syndrome. Clinical Discussion: In our case, the non-specific clinical symptoms correlated with histopathological examinations led to the initial diagnosis of Helicobacter Pylori-induced gastritis. Surprisingly, the lack of improvements led to performing CT scan, which confirmed the diagnosis of SMA syndrome. Subsequently, HP gastritis played a significant role in misleading and delaying the diagnosis. Conclusion: We report the first case report from Syria of s superior mesenteric artery syndrome that was misdiagnosed and preceded by HP-induced gastritis, highlighting the crucial role of detailed clinical and radiological examinations in the diagnosis of challenging cases with morbid complications.

Evaluating aortomesenteric parameters in a tertiary center of Nepal for superior mesenteric artery syndrome diagnosis and risk factors: cross-sectional study.

This study examines aortomesenteric angle (AMA) and distance (AMD), which are critical in superior mesenteric artery (SMA) syndrome. Addressing the scarcity of SMA cases, the research explores potential links with lower BMI and aims to establish normative data for diagnostic and predictive purposes, using contrast-enhanced computed tomography (CT) scans across various BMI and sex categories. A retrospective quantitative cross-sectional study was conducted on 189 patients undergoing abdominal contrast-enhanced CT scans between December 2019 and December 2020. Ethical clearance was obtained, and participants provided informed consent. Exclusion criteria targeted specific medical histories. Patient demographics, BMI categories, and imaging data were recorded. Helical 128-slice CT scans were employed, with sagittal-oblique multiplanar reconstructions for parameter assessments. Statistical analysis utilized SPSS 26.0, including Pearson correlation coefficients and mean calculations. The study reveals a mean AMA of 54.07°±8.53° and a mean distance of 16.25±3.44 mm. Elevated BMI is found to positively correlate with AMA and distance, indicating that higher BMI values may augment these parameters, with an additional positive correlation observed between AMA and distance. No significant correlations are found with patient age or sex. The study concludes that decreased BMI may pose a potential risk for SMA syndrome, as evidenced by the observed correlations with aortomesenteric parameters. Understanding these normal values in the Nepalese population is critical for accurate diagnoses and predictions using CT scans. The research highlights the impact of demographic factors on these parameters and emphasizes their significance in clinical assessments related to SMA syndrome.

Vascular compression syndromes in the abdomen and pelvis: a concise pictorial review.

Vascular compression syndromes are a diverse group of pathologies that can manifest asymptomatically and incidentally in otherwise healthy individuals or symptomatically with a spectrum of presentations. Due to their relative rarity, these syndromes are often poorly understood and overlooked. Early identification of these syndromes can have a significant impact on subsequent clinical management. This pictorial review provides a concise summary of seven vascular compression syndromes within the abdomen and pelvis including median arcuate ligament (MAL) syndrome, superior mesenteric artery (SMA) syndrome, nutcracker syndrome (NCS), May-Thurner syndrome (MTS), ureteropelvic junction obstruction (UPJO), vascular compression of the ureter, and portal biliopathy. The demographics, pathophysiology, predisposing factors, and expected treatment for each compression syndrome are reviewed. Salient imaging features of each entity are illustrated through imaging examples using multiple modalities including ultrasound, fluoroscopy, CT, and MRI.

Superior mesenteric artery syndrome

El síndrome de la arteria mesentérica superior (SAMS), también conocido como síndrome de Wilkie, es una obstrucción intestinal alta ocasionada por la compresión vascular de la tercera porción del duodeno por la arteria mesentérica superior sobre la aorta abdominal 1,2 (Figura 1). Es una patología poco frecuente, con una incidencia del 0,2 %, más común en mujeres (2:1) entre los 10 y 30 años, principalmente en pacientes con pérdida de peso rápido, que conlleva alta morbimortalidad 3,4.

Delayed presentation of Wilkie’s syndrome after scoliotic curve correction surgery: a case report

BackgroundSuperior mesenteric artery (SMA) syndrome, also known as Wilkie’s syndrome, is a rare but serious complication following scoliosis correction surgery. It occurs as a result of mechanical compression of third part of duodenum between the SMA and aorta. This condition occurs most commonly in significantly underweight patients with deformities, and usually during the first week following spinal deformity corrective surgeries. The angle between the abdominal aorta and the SMA gets reduced following spinal lengthening during deformity correction surgery causing compression of third part of duodenum resulting in development of SMA syndrome.Case presentation.We present a case of 17-year-old male with congenital scoliosis with a 70-degree scoliotic curve who underwent spinal deformity correction surgery with posterior instrumented fusion. Post-operative course was uneventful and the patient was discharged after suture removal on post-operative day 15. The patient presented after 21-days of symptom onset on post-operative-day 51, with a 3 week history of post-prandial vomiting, abdominal pain and distension which resulted in rapid weight loss of 11 kg. A CT-angiogram showed obstruction at third part of duodenum. After reviewing clinical and radiological profile of the patient, a diagnosis of SMA syndrome was made. Conservative management was tried, but due to rapid deterioration of patient condition and symptoms of complete intestinal obstruction, the patient was treated surgically by gastro-jejunostomy and side-to-side jejuno-jejunostomy, which improved his condition.ConclusionSMA syndrome can occur much later than previously reported cases and with potentially life-threatening symptoms following scoliosis correction. Having a high index of suspicion, early recognition of condition and institution of appropriate treatment are essential to prevent occurrence of severe complications including risk of intestinal perforation and mortality. This case highlights management of delayed onset of SMA syndrome, with presentation further delayed after symptom onset, as is common in developing parts of the world, due to limited availability and accessibility of resources, and low socio-economic status of large segments of the population.

Before Diagnosing Superior Mesenteric Artery (Wilkies) Syndrome in MELAS, other causes of Gastroparesis must be ruled out

Before Diagnosing Superior Mesenteric Artery (Wilkies) Syndrome in MELAS, other causes of Gastroparesis must be ruled out

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.

Anesthesia experience in an adult Silver-Russell syndrome: a case report

BackgroundThere are no reports of anesthesia use in adult patients with Silver-Russell syndrome (SRS). Here, we report our experience with anesthesia in an adult patient with SRS complicated by chronic respiratory failure.Case presentationA 33-year-old woman was clinically diagnosed with SRS. She had severe chronic respiratory failure, complicated by superior mesenteric artery syndrome. Percutaneous gastrostomy was scheduled for nutritional management under epidural anesthesia; however, soon after esophagogastroduodenoscopy was started, she lost consciousness and spontaneous respiration. The patient was urgently intubated and converted to general anesthesia. The end-tidal carbon dioxide tension was > 90 mmHg at intubation.ConclusionsAdult SRS patients with chronic respiratory failure have a risk of CO2 narcosis. SRS also requires preparation for difficult airway management during the perioperative period.

Autosomal Recessive Leber Hereditary Optic Neuropathy Triggered by Superior Mesenteric Artery Syndrome.

Autosomal Recessive Leber Hereditary Optic Neuropathy Triggered by Superior Mesenteric Artery Syndrome.

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 post-total proctocolectomy: A challenging post-operative dilemma

Superior mesenteric artery (SMA) syndrome is a rare condition characterized by small bowel obstruction due to compression of the third portion of the duodenum by the SMA and the abdominal aorta. Also, known as Wilkie’s Syndrome, it has a reported incidence of 0.1–0.3%. Confirmation of SMA is classically demonstrated by the decreased aortomesenteric angle with dilatation of the second part of the duodenum and compression of the third part. Medical treatment is usually successful in patients with a short history and a relatively minor degree of duodenal stasis. In patients not responding to conservative management, surgical interventions have been implicated. Post-operative incidence of SMA syndrome is still rarer and has been most commonly seen after spinal surgeries. SMA syndrome after colectomies has a few reported cases in world literature. We present a case of SMA syndrome after total proctocolectomy for carcinoma colon with polyposis coli, managed successfully with conservative treatment.

416 - Superior mesenteric artery syndrome as initial presentation for crohn’s colitis in adolescent male

416 - Superior mesenteric artery syndrome as initial presentation for crohn’s colitis in adolescent male

Gastrointestinal Complications of Mitochondrial Encephalomyopathy, Lactic Acidosis and Stroke-Like Episodes (MELAS) Syndrome Managed By Parenteral Nutrition.

Gastrointestinal complications of MELAS such as chronic intestinal pseudo-obstruction, pancreatitis and gastroparesis can lead to undernutrition.Superior mesenteric artery syndrome is a rare condition but should be considered in cases with significant weight loss and resistance to symptomatic treatment.Optimal caloric intake and energy support can improve the condition of patients with MELAS.

Superior mesenteric artery syndrome: A tough nut to crack – A rare complication in the management of oligometastatic colorectal carcinoma

The superior mesenteric artery (SMA) syndrome is a rare cause of intestinal obstruction. However, conditions associated with rapid weight loss, including malignancy, burns, bariatric surgery, and trauma, can precipitate the syndrome. Recognition of the syndrome requires a high index of suspicion and a multidisciplinary approach in conjunction with the radiologist. Here, we present the case of a patient with metastatic colon cancer, who developed symptoms of abdominal pain and hematuria after undergoing a local ablative procedure for liver metastases. He was extensively evaluated, in view of a history of abdominal pain in the supine position and relieved in the prone position, along with a history of similar complaints following an earlier colectomy procedure and a history of weight loss. In view of this unusual symptom complex coupled with the radiologic findings on the ultrasound, he underwent a barium swallow which showed duodenal dilation and a reduced aortomesenteric angle. Thus, a diagnosis of the SMA syndrome with the nutcracker phenomenon was made. The patient was managed conservatively and is on regular follow-up. The case highlights the need for a multidisciplinary approach, with an innocuous observation in tandem with the clinical history being pivotal in clinching a rare diagnosis.

Superior Mesenteric Artery Syndrome, a Rare Complication of Severe Malnutrition: Two Cases from a Subsaharian Endocrinology Department

Superior Mesenteric Artery Syndrome, a Rare Complication of Severe Malnutrition: Two Cases from a Subsaharian Endocrinology Department

Wilkie syndrome, a rare chronic intestinal occlusion syndrome, to be considered in the differential diagnosis of gastrointestinal neoplasms

Wilkie syndrome, also known as Cast syndrome, is a very rare vascular disease with an incidence of 0.2-0.7% and most often occurs in women. The decrease of the retroperitoneal perivascular fatty cushions which causes the decrease of the aortomesenteric angle and extrinsic compression of the third portion of the duodenum which generates symptoms of intestinal occlusion and weight loss, in most of the patients this pathology can have a chronic course. We present the case of a 58-year-old male patient, with no relevant history, who presents to the emergency department due to dehydration, involuntary weight loss, abdominal distension, oral intolerance, nausea and vomiting. Medical management was started to improve general conditions, diagnostic protocol was initiated due to clinical picture of intestinal occlusion, and finally a diagnosis of Wilkie syndrome was established with the help of abdomino-pelvic tomography with intravenous contrast, surgery was performed with exploratory laparotomy, and laterolateral duodenojejunal anastomosis in two planes, the patient had an adequate postoperative evolution with adequate tolerance to the oral route, and was discharged home without complications.

La sindrome del compasso aortomesenterico

Wilkie syndrome (aortic-mesenteric compass) was eventually diagnosed in a 15 year old girl presenting with bilious vomiting and gastric distention.

Ultrasound characteristics of abdominal vascular compression syndromes.

Abdominal vascular compression syndrome (AVCS) is caused by the compression of abdominal blood vessels by adjacent structures or the compression of abdominal organs by neighboring blood vessels. Such compressions can result in a variety of clinical symptoms. They are not commonly seen in ultrasound practices, and their presence may have been underrecognized and underdiagnosed. This article reviews the clinical features, ultrasound characteristics, and diagnostic criteria of four types of AVCS, namely, celiac artery compression syndrome, renal vein compression syndrome, iliac vein compression syndrome, and superior mesenteric artery syndrome to increase awareness of these conditions among ultrasound practitioners. The ultrasound criteria for AVCS are primarily based on studies with small sample sizes, and therefore, it is important to exercise caution if these criteria are used.

Unveiling the Significance of Body Mass Index in Diagnosis of Superior Mesenteric Artery Syndrome: A Hidden Link

Background & Aims: The superior mesenteric artery syndrome (SMAS) is an uncommon syndrome characterized by the compression of the third part of the duodenum between the superior mesenteric artery (SMA) and abdominal aorta with resultant proximal duodenal dilatation. The radiological diagnosis of the SMAS is based on reduced angle and distance between the SMA and aorta in presence of proximal duodenal dilatation. A reduction in these is closely associated with depletion of the mesenteric fat between the vessels. Our primary aim is to establish the relationship, if any, of body mass index (BMI) with the angle and distance between the SMA and abdominal aorta in general population. Materials and Methods: This study was carried out in 200 patients who had undergone contrast enhanced computed tomography for various other complaints. Various parameters such as aortomesenteric distance (AMD) and aortomesenteric angle (AMA) along with the body mass indices were calculated. Pearson correlation coefficients were calculated to establish the relationship between BMI, AMD and AMA. Results: Pearson’s correlation coefficient for BMI and AMD was 0.868, indicating strong positive correlation and 0.577 for BMI and AMA, indicating moderate positive correlation. Furthermore, AMD and AMA also showed positive correlation with Pearson’s correlation coefficient of 0.568. Conclusion: There is significant positive correlation of BMI with AMD and AMA in general population suggesting people with low BMI are at an increased risk of developing SMAS. Keywords: Aortomesenteric angle, Aortomesenteric Distance, Body mass index, Superior mesenteric Artery Syndrome. Computed Tomography

A Case of Intractable Vomiting Due to Superior Mesenteric Artery Syndrome

Superior Mesenteric Artery Syndrome (SMAS) is a chronic mechanical obstruction of the duodenum due to compression of the superior mesenteric artery (SMA) at the level of the duodenum, with corresponding symptoms that can be improved with postural changes. Gastrointestinal symptoms may improve with positional changes. This kind of disease is very rare in clinic, we now review a case of intractable vomiting caused by superior mesenteric artery syndrome in our hospital, and report the details as follows.