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

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Rebecca Nunn ◽  
Jaimie Henry ◽  
Alistair A. P. Slesser ◽  
Rukshan Fernando ◽  
Nebil Behar
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Epigastric Pain ◽  
Left Renal Vein ◽  
Clinical Manifestations ◽  
External Compression ◽  
Nutcracker Phenomenon ◽  
Narrow Angle ◽  
Sma Syndrome ◽  
History Of

Superior mesenteric artery (SMA) syndrome is a rare cause of gastrointestinal obstruction, caused by external compression of the third part of the duodenum by the SMA. It may be associated with the Nutcracker phenomenon: external compression of the left renal vein. To our knowledge, there are few reports in the literature describing the coexistence of these two conditions and so we take this opportunity to highlight a rare cause of the acute abdomen that might otherwise be overlooked in cases of nonspecific abdominal findings and potentially unremarkable initial investigations. We report a case of SMA syndrome and Nutcracker phenomenon in a 19-year-old female who presented to our emergency department with a short history of epigastric pain and emesis. The SMA syndrome is thought to develop as the result of an abnormally narrow angle between the proximal SMA and the aorta, for which a number of predisposing factors have been described. Surgical options exist; however, the SMA syndrome is typically managed conservatively in the first instance, consistent with the approach described in this case. The Nutcracker phenomenon may give rise to the Nutcracker syndrome in the presence of typical clinical manifestations; however, these did not feature in this case.

scholarly journals Superior Mesenteric Artery Syndrome: Clinical and Radiological Considerations

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
M. Ezzedien Rabie ◽  
Olajide Ogunbiyi ◽  
Abdullah Saad Al Qahtani ◽  
Sherif B. M. Taha ◽  
Ahmad El Hadad ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Barium Meal ◽  
Clinical Manifestations ◽  
Rare Condition ◽  
Sma Syndrome ◽  
Ligament Of Treitz ◽  
History Of ◽  
Initial Improvement

Background. Superior mesenteric artery (SMA) syndrome is a rare condition of duodenal obstruction, caused by the overlying SMA.Aim. To report on our experience with the management of SMA syndrome, drawing the attention to its existence.Material and Methods. We reviewed our records to identify cases diagnosed with SMA syndrome, in the period from October 1995 to January 2012.Results. Seven patients were identified, one male and six females. Their mean age was 17.1 years. Vomiting and abdominal pain were the presenting complaints in all patients and history of weight loss was present in six of them. In no patient was the diagnosis suspected initially on clinical grounds. Only after radiological investigations was the diagnosis declared. Radiology took the form of gastrografin/barium meal only in four patients and both gastrografin/barium meal and computerized tomography scan in the remaining three. Four patients responded to medical treatment and surgery was performed in the remaining three, with open duodenojejunostomy in two patients and laparoscopic dissection of the ligament of Treitz in the third. Long lasting improvement was sustained in all patients except one in the surgery group who, despite initial improvement, still has infrequent attacks of abdominal pain.Conclusion. Although the clinical manifestations of SMA syndrome are shared with many other disease entities, it has unique radiological as well as endoscopic features, which enables a confident diagnosis to be made. Once diagnosed, conservative treatment with nutritional support and positioning should be tried first. In case of unresponsiveness, surgery may give a lasting cure.

scholarly journals Epigastric Pain and Weight Loss – A Case of Wilkie’s Syndrome

2020 ◽  
Author(s):  
Ana Lima Silva ◽  
Daniela Antunes ◽  
Joana Cordeiro Cunha ◽  
Renato Nogueira ◽  
Diana Fernandes ◽  
...  
Keyword(s):  
Weight Loss ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Epigastric Pain ◽  
Gastrointestinal Symptoms ◽  
Laboratory Findings ◽  
Wilkie’S Syndrome ◽  
Sma Syndrome ◽  
Computed Tomography Enterography ◽  
History Of

Superior mesenteric artery syndrome (SMA syndrome) or Wilkie’s syndrome is a rare etiology of duodenal obstruction due to compression of the third portion of the duodenum between the superior mesenteric artery and the aorta. Physical and laboratory findings are often non-specific but imaging methods are useful for diagnosing the condition. A 46-year-old female patient presented to the outpatient clinic of our internal medicine department with a 2-year history of epigastric pain, nausea, early satiety and weight loss of 15 kg. Previous studies were inconclusive. The patient underwent computed tomography enterography and its findings were consistent with SMA syndrome. Currently the patient is being followed by General Surgery and Nutrition and is under nutritional measures in order to optimize her body mass index to decrease possible surgical complications.This case report emphasizes the importance of clinical suspicion and careful investigation when considering less common etiologies for frequent gastrointestinal symptoms.

scholarly journals Superior mesenteric artery syndrome in a healthy active adolescent

2019 ◽  
Vol 12 (8) ◽  
pp. e228758
Author(s):  
Tsuyoshi Okamoto ◽  
Takumi Sato ◽  
Yukio Sasaki
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Epigastric Pain ◽  
Growth Spurt ◽  
Pubertal Growth Spurt ◽  
Early Puberty ◽  
Pubertal Growth ◽  
Sma Syndrome ◽  
No Weight Loss ◽  
Common Risk Factors

This report discusses a case of superior mesenteric artery (SMA) syndrome in a previously healthy 15-year-old boy with no weight loss or other common risk factors. The patient presented to the emergency department with acute bilious vomiting and epigastric pain after acute consumption of a meal and excessive quantities of water. The patient was diagnosed with SMA syndrome based on the findings of contrasted CT of the abdomen. In early puberty, boys have a significant increase in lean body mass and a concomitant loss of adipose tissues. These pubertal changes lead to a narrowing of the aortomesenteric space. The acute consumption of food and water caused a transient obstruction at the already-narrowed space, which resulted in the manifestation of SMA syndrome. This case demonstrates that pubertal growth spurt is a risk factor for SMA syndrome, and acute excessive ingestion can trigger SMA syndrome among those in puberty.

scholarly journals Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice

2017 ◽  
Vol 99 (6) ◽  
pp. 472-475 ◽  
Author(s):  
GC Kirby ◽  
ER Faulconer ◽  
SJ Robinson ◽  
A Perry ◽  
R Downing
Keyword(s):  
Weight Loss ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Epigastric Pain ◽  
Superior Mesenteric Artery Syndrome ◽  
Team Approach ◽  
The Third ◽  
Wilkie’S Syndrome ◽  
Sma Syndrome ◽  
Open Gastrojejunostomy

INTRODUCTION The superior mesenteric artery (SMA) syndrome, or Wilkie’s syndrome, is a rare cause of postprandial epigastric pain, vomiting and weight loss caused by compression of the third part of the duodenum as it passes beneath the proximal superior mesenteric artery. The syndrome may be precipitated by sudden weight loss secondary to other pathologies, such as trauma, malignancy or eating disorders. Diagnosis is confirmed by angiography, which reveals a reduced aorto-SMA angle and distance, and contrast studies showing duodenal obstruction. Conservative management aims to increase intra-abdominal fat by dietary manipulation and thereby increase the angle between the SMA and aorta. Where surgery is indicated, division of the ligament of Treitz, anterior transposition of the third part of the duodenum and duodenojejunostomy have been described. METHODS We present four cases of SMA syndrome where the intention of treatment was laparoscopic duodenojejunostomy. The procedure was completed successfully in three patients, who recovered quickly with no short-term complications. A fourth patient underwent open gastrojejunostomy (complicated by an anastomotic bleed) when dense adhesions prevented duodenojejunostomy. CONCLUSIONS The superior mesenteric artery syndrome should be considered in patients with epigastric pain, prolonged vomiting and weight loss. Laparoscopic duodenojejunostomy is a safe and effective operation for management of the syndrome. A multi-speciality team approach including gastrointestinal, vascular and radiological specialists should be invoked in the management of these patients.

Superior Mesenteric Artery Syndrome in the Modern Trauma Patient

2007 ◽  
Vol 73 (8) ◽  
pp. 803-806 ◽  
Author(s):  
John B. Adams ◽  
Michael L. Hawkins ◽  
Coville H. Ferdinand ◽  
Regina S. Medeiros
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Muscle Tone ◽  
Surgical Techniques ◽  
Bed Rest ◽  
External Compression ◽  
Severe Burns ◽  
Sma Syndrome ◽  
Loss Of Weight ◽  
Abdominal Wall Muscle

In 1861, von Rokitansky described obstruction of the third part of the duodenum by external compression of the duodenum by the superior mesenteric artery (SMA). In 1926, this entity was furthermore described by Wilke in his presentation of 75 patients with “chronic duodenal compression”. In 1968, Mansberger used angiography to define anatomical measurements as the diagnostic criteria for this condition. Current modalities of diagnosis of SMA syndrome include esophagogastroduodenoscopy, computerized tomography angiogram, fluoroscopy, transabdominal ultrasound, and endoscopic ultrasound. The SMA syndrome has been associated with prolonged confinement in the supine position, loss of weight, loss of abdominal wall muscle tone, application of a body cast, and severe burns. With current surgical techniques allowing early ambulation, patients are able to avoid prolonged bed rest. The use of parenteral and enteral nutritional support has limited the loss of weight associated with trauma and burn patients, making this syndrome uncommon in this patient population. Recent reports of SMA syndrome focus on the association with corrective surgical procedures for scoliosis and obesity.

scholarly journals 1517 Case Report: Concomitant Superior Mesenteric Artery and Nutcracker Syndrome

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M G Rivera Cartland ◽  
R Camprodon
Keyword(s):  
Case Report ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Multidetector Ct ◽  
Left Renal Vein ◽  
Outlet Obstruction ◽  
Vascular Compression ◽  
Sma Syndrome ◽  
Surgical Bypass ◽  
Operative Findings

Abstract Background Superior mesenteric artery (SMA) syndrome is a rare1 upper gastrointestinal emergency and diagnosis is reached by a high clinical suspicion and confirmed on CT scan. It classically occurs from the compression of the third part of the duodenum (D3) due to a reduced aorto-mesenteric angle2. Case report A 28-year-old Caucasian female presented with a 4-day history of persistent vomiting, generalised abdominal pain, distension and absolute constipation for 3 days. She has no previous past medical history. On examination, she had a BMI of 17. Her abdomen was distended with generalised tenderness on palpation. Her routine blood results showed stage 2 acute renal failure. CT abdomen and pelvis showed a grossly dilated stomach and part 1& 2 of duodenum. She underwent an emergency Roux-en-Y duodeno-jejunostomy and end-side jejuno-jejunal anastomosis. Operative findings were of a grossly distended stomach and D1/2 with superior mesenteric vessels impinging on D3 and on left renal vein. Conclusions SMA syndrome is a rare cause of gastric outlet obstruction and following initial hydration and correction of electrolytes a definitive procedure should be considered. Many surgeons favour a conservative approach with a period of ‘fattening’ to increase the aorto-mesenteric angle prior to surgical management. We believe that this only delays the inevitable and patients are best serviced with early surgical bypass. References 1. Biswas A. Superior mesenteric artery syndrome: CT findings. BMJ Case Rep. 2016 2. Multidetector CT of vascular compression syndromes in the abdomen and pelvis. RadioGraphics 2014;34:93–115. 10.1148/rg.341125010

Antibiotic Therapy Did Not Prevent the Rupture of Mycotic Aneurysm of the Superior Mesenteric Artery

2015 ◽  
Vol 18 (3) ◽  
pp. 088
Author(s):  
Ye-tao Li ◽  
Xiao-bin Liu ◽  
Tao Wang
Keyword(s):  
Abdominal Pain ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mycotic Aneurysm ◽  
Acute Abdominal Pain ◽  
Rare Complication ◽  
Emergency Operation ◽  
History Of

<p class="p1"><span class="s1">Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.</span></p>

Superior mesenteric artery (SMA) syndrome: an unusual cause of intestinal obstruction in palliative care

2017 ◽  
Vol 6 (1) ◽  
pp. 91-93 ◽  
Author(s):  
Chun-Yan So ◽  
Kwok-Ying Chan ◽  
Ho-Yan Au ◽  
Man-Lui Chan ◽  
Theresa Lai
Keyword(s):  
Palliative Care ◽  
Intestinal Obstruction ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Sma Syndrome

scholarly journals A clinical course of a patient with anorexia nervosa receiving surgery for superior mesenteric artery syndrome

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ken Kurisu ◽  
Yukari Yamanaka ◽  
Tadahiro Yamazaki ◽  
Ryo Yoneda ◽  
Makoto Otani ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Anorexia Nervosa ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Rare Complication ◽  
Nutrition Therapy ◽  
Psychological Status ◽  
Sma Syndrome

Abstract Background Superior mesenteric artery (SMA) syndrome is a well-known but relatively rare complication of anorexia nervosa. Although several reports have proposed surgery for SMA syndrome associated with anorexia nervosa, these have shown poor outcomes or did not reveal the long-term weight course. Thus, the long-term effectiveness of surgery for SMA syndrome in such cases remains unclear. This case report describes a patient with anorexia nervosa who underwent surgery for SMA syndrome. Case presentation An 18-year-old woman presented with anorexia nervosa when she was 16 years old. She also presented with SMA syndrome, which seemed to be caused by weight loss due to the eating disorder. Nutrition therapy initially improved her body weight, but she ceased treatment. She reported that symptoms related to SMA syndrome had led to her weight loss and desired to undergo surgery. Laparoscopic duodenojejunostomy was performed, but her body weight did not improve after the surgery. The patient eventually received conservative nutritional treatment along with psychological approaches, which led to an improvement in her body weight. Conclusions The case implies that surgery for SMA syndrome in patients with anorexia nervosa is ineffective for long-term weight recovery and that conservative treatment can sufficiently improve body weight; this is consistent with the lack of evidence on the topic and reports on potential complications of surgery. Due to difficulties in assessing psychological status, consultation with specialists on eating disorders is necessary for treating patients with severely low body weight.

Sign in / Sign up

Export Citation Format

Share Document