scholarly journals Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Emanuele Sinagra ◽  
Dario Raimondo ◽  
Domenico Albano ◽  
Valentina Guarnotta ◽  
Melania Blasco ◽  
...  
Keyword(s):  
Weight Loss ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Control Group ◽  
Diagnosis And Management ◽  
Sma Syndrome ◽  
Aortomesenteric Angle ◽  
Cect Scan ◽  
Enhanced Computed Tomography ◽  
Aortomesenteric Distance

Background. The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required. Aims and Methods. This study aims at analyzing the clinical presentation, diagnosis, and management of SMA syndrome. Ten cases of SMA syndrome out of 2074 esophagogastroduodenoscopies were suspected. A contrast-enhanced computed tomography (CECT) scan was performed to confirm the diagnosis. After, a gastroenterologist and a nutritionist personalized the therapy. Furthermore, we compared the demographical, clinical, endoscopic, and radiological parameters of these cases with a control group consisting of 10 cases out of 2380 EGDS of initially suspected (but not radiologically confirmed) SMA over a follow-up 2-year period (2015-2016). Results. The prevalence of SMA syndrome was 0.005%. Median age and body mass index were 23.5 years and 21.5 kg/m2, respectively. Symptoms developed between 6 and 24 months. Median aortomesenteric angle and aorta-SMA distance were 22 and 6 mm, respectively. All patients improved on conservative treatment. In our series, a marked (>5 kg) weight loss (p=0.006) and a long-standing presentation (more than six months in 80% of patients) (p=0.002) are significantly related to a diagnosis of confirmed SMA syndrome at CECT after an endoscopic suspicion. A “resembling postprandial distress syndrome dyspepsia” presentation may be helpful to the endoscopist in suspecting a latent SMA syndrome (p=0.02). The narrowing of both the aortomesenteric angle (p=0.001) and the aortomesenteric distance (p<0.001) was significantly associated with the diagnosis of SMA after an endoscopic suspicion; however, the narrowing of the aortomesenteric distance seemed to be more accurate, rather than the narrowing of the aortomesenteric angle. Conclusion. SMA syndrome represents a diagnostic and therapeutic challenge. Our results show the following findings: the importance of the endoscopic suspicion of SMA syndrome; the preponderance of a long-standing and chronic onset; a female preponderance; the importance of the nutritional counseling for the treatment; no need of surgical intervention; and better diagnostic accuracy of the narrowing of the aorta-SMA distance. Larger prospective studies are needed to clarify the best diagnosis and management of the 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.

scholarly journals Superior mesenteric artery syndrome: A rare complication of scoliosis corrective surgery

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902094501
Author(s):  
Weng Hong Chung ◽  
Amir Arif Anuar ◽  
Keong Joo Lee ◽  
Mohd Shahnaz Hasan ◽  
Chee Kidd Chiu ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Early Diagnosis ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Nutritional Support ◽  
Rare Complication ◽  
Scoliosis Surgery ◽  
Key Factors ◽  
Diagnosis And Management ◽  
Sma Syndrome

Superior mesenteric artery (SMA) syndrome is a rare but serious complication following scoliosis surgery. Early diagnosis and management are key factors for successful conservative treatment to avoid the need for emergency laparotomies which causes higher morbidity or even mortality. We report two adolescent idiopathic scoliosis patients with Cobb angle of 49° and 132°, respectively, and low body mass index who presented with SMA syndrome following posterior spinal fusion from T2 to L3 and were treated successfully with conservative management. Abdominal radiographs showed distended gastric shadow. Computed tomography angiography of the abdomen showed decreased aortomesenteric angle and SMA-aorta distance. Both patients were treated successfully with conservative treatment which included three principles: gastric decompression with nasogastric tube, correction of electrolytes imbalance, and nutritional support with low volume, high calorie nutritional supplement. Both patients were started with small but frequent meals. Surgeries were not required in both cases. Early diagnosis and management are the key factors to successful treatment in SMA syndrome. Patients with SMA can be treated successfully with conservative treatment comprising of nasogastric decompression, electrolyte correction, and nutritional support with small but frequent meals.

scholarly journals Superior mesenteric artery syndrome in a patient with celiacomesenteric trunk

2021 ◽  
Vol 14 (2) ◽  
pp. e237132
Author(s):  
Swanit Hemant Deshpande ◽  
Jenny Thomas ◽  
Roshan Chiranjeev ◽  
Jayashri Sanjay Pandya
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Anatomic Variation ◽  
Mesenteric Arteries ◽  
Uneventful Recovery ◽  
Common Trunk ◽  
Sma Syndrome ◽  
Coeliac Trunk ◽  
Aortomesenteric Angle ◽  
Celiacomesenteric Trunk

Superior mesenteric artery (SMA) syndrome is an uncommon entity leading to compression of the duodenum between the aorta and the SMA. Normally the coeliac trunk and the superior mesenteric arteries have distinct origins from the abdominal aorta. The celiacomesenteric trunk (CMT) is the least frequently reported anatomic variation of all abdominal vascular anomalies. CMT denotes a common trunk of origin of the coeliac and superior mesenteric arteries. The coexistence of these anomalies has never been reported in the literature. We present a case of a 59-year-old man presenting with duodenal obstruction due to SMA syndrome with CMT. The aortomesenteric angle was 13 degrees and SMA-aorta distance was 8 mm. Patient underwent a gastrojejunostomy. After an uneventful recovery, the patient has been symptom free for 1-year follow-up.

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: 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.

scholarly journals Superior Mesenteric Artery Syndrome Associated with Rapid Weight Loss Attributed to Amphetamine Abuse

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Richard M. Fazio ◽  
On Chen ◽  
Wael Eldarawy
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Superior Mesenteric Artery ◽  
Female Patient ◽  
Mesenteric Artery ◽  
Rapid Weight Loss ◽  
Amphetamine Abuse ◽  
The Third ◽  
Sma Syndrome ◽  
Number Of Factors

Superior mesenteric artery (SMA) syndrome arises from a reduction in the angle formed between the SMA and the aorta, thereby compressing the third portion of the duodenum. This phenomenon may be caused by a number of factors, one of which being acute weight loss. We report a case of a female patient presenting with abdominal pain and vomiting who developed superior mesenteric artery (SMA) syndrome as a result of rapid weight loss, thought to be secondary to amphetamine abuse. This association can often be overlooked and, to our knowledge, has not been previously reported.

Unusual presentation of superior mesenteric artery syndrome after trauma

2021 ◽  
Vol 14 (1) ◽  
pp. e238578
Author(s):  
Laxman Yashwant Byreddi ◽  
Arunima Dutta ◽  
Kavitha Kesari
Keyword(s):  
Weight Loss ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Clavicle Fracture ◽  
Jejunostomy Tube ◽  
Severe Condition ◽  
Sma Syndrome ◽  
Ct Angiogram ◽  
Cord Injury ◽  
Repeat Imaging

Superior mesenteric artery (SMA) syndrome is a rare but severe condition. SMA syndrome’s association with trauma has been reported to present weeks to months after significant weight loss due to head or spinal cord injury. We present an unusual case of SMA syndrome presenting with obstructive symptoms, which developed immediately after clavicle fracture and was not associated with weight loss. CT of the abdomen showed small bowel obstruction in the third part of the duodenum. CT angiogram of the abdomen confirmed SMA syndrome. The patient was managed conservatively with enteral nutrition via jejunostomy tube. He was discharged after symptoms resolved, and repeat imaging revealed resolution of obstruction. This case emphasises the importance of having SMA syndrome as one of the differential diagnoses for patients presenting with obstructive symptoms after trauma because early diagnosis can be managed with conservative treatment.

Angulation and Distance of Superior Mesenteric Artery According to Body Mass Index on Patients Based on Computed Tomography Scan Study at Chitwan Medical College

2019 ◽  
Vol 9 (3) ◽  
pp. 74-78
Author(s):  
Deepak Adhikari ◽  
Sudil Paudyal ◽  
Bigyan Paudel ◽  
Dipesh Paudel ◽  
Ishwor Acharya
Keyword(s):  
Computed Tomography ◽  
Body Mass Index ◽  
Superior Mesenteric Artery ◽  
Body Mass ◽  
Mesenteric Artery ◽  
Significant Positive Correlation ◽  
Positive Correlation ◽  
Medical College ◽  
Aortomesenteric Angle ◽  
Aortomesenteric Distance

 Background: Superior mesenteric artery syndrome is a rare but vital cause of upper gastrointestinal obstruction which occurs when the third portion of the duodenum is trapped between aorta and superior mesenteric artery. The sig­nificant decrease of the angle and distance between the superior mesenteric artery and aorta is the etiology of Superior mesenteric artery syndrome.The study aimed to identify the angulations and distance of superior mesenteric artery from aorta and their correlation with body mass index in patients re­ferred for contrast enhanced computed tomography of abdomen examination in Chitwan Medical College. Methods: The angle between the aorta and superior mesenteric artery was measured in arterial phase of the abdominal scan in the multiplanar recon­structed image in sagittal plane. The distance between the superior mesen­teric artery and aorta was measured in axial plane at the level of 3rd part of duodenum. Results: The aortomesenteric distance was obtained to be 13.30 ± 4.75 mm and the aortomesenteric angle was obtained to be 54.7±16.91 degree for a to­tal of 210 patients. There was a positive correlation between body mass index and aortomesenteric distance (p=0.086) and significant positive correlation between body mass index and aortomesenteric angle (p=0.122). Additionally, it showed there was significant positive correlation between aortomesenteric angle and aortomesenteric distance. Conclusions: The distance and angle between the superior mesenteric artery and the aorta correlates significantly with the body mass index which indicates that the decrease in body mass index can be used as a risk factor of superior mesenteric artery syndrome.

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
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