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

Superior mesenteric artery (SMA) syndrome (also known as Wilkie’s syndrome) is an unusual cause of proximal intestinal obstruction, attributable to vascular compression of the third part of duodenum between the superior mesenteric artery and the abdominal aorta due to acute angulation of SMA. It is a life threatening disease as it poses a diagnostic dilemma and often diagnosed by exclusion of other causes. It is an acquired disorder and is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a case of SMA syndrome in a 23 year young asthenic female patient, with a long history of recurrent abdominal pain, epigastric fullness, voluminous vomiting, and weight loss. Symptoms persisted for 1 year and the patient underwent extensive investigations, but to no avail. Thereafter she developed proximal intestinal obstruction, which unravelled her diagnosis. Abdominal examination revealed epigastric fullness, tenderness and hyper peristaltic bowel sounds. We performed small bowel enteroclysis, upper gastrointestinal series, abdominal computer-tomography (CT) and ultrasonography to establish the diagnosis. Conservative treatment was tried for one month but failed. There was no relief of symptoms in the left lateral decubitus or prone position. Finally, the patient successfully underwent Roux-en-Y duodenojejunal anastomosis with a postoperative favourable outcome. This case emphasizes the challenges in the diagnosis of SMA syndrome and the need for increased awareness of this entity. This will improve early recognition in order to reduce irrelevant tests and unnecessary treatments.

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G84(P) Superior mesenteric artery (SMA) syndrome: An unusual cause of proximal intestinal obstruction

Archives of Disease in Childhood ◽

10.1136/archdischild-2014-306237.84 ◽

2014 ◽

Vol 99 (Suppl 1) ◽

pp. A36-A36

Author(s):

S. Rajdev ◽

N. Briscoe ◽

A. Pigott ◽

M. Jones ◽

C. Hall

Keyword(s):

Intestinal Obstruction ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Sma Syndrome

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Superior mesenteric artery syndrome masquerading as chronic gastric volvulus in a child with severe acute malnutrition: a case report

International Surgery Journal ◽

10.18203/2349-2902.isj20203272 ◽

2020 ◽

Vol 7 (8) ◽

pp. 2758

Author(s):

M. Mokarram Ali ◽

Amit Kumar ◽

Rashi . ◽

Amit K. Sinha ◽

Bindey Kumar

Keyword(s):

Intestinal Obstruction ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Severe Acute Malnutrition ◽

Gastric Volvulus ◽

Acute Malnutrition ◽

Severe Malnutrition ◽

Sma Syndrome ◽

Paediatric Age ◽

High Index Of Suspicion

Superior mesenteric artery (SMA) syndrome is a rare cause of high intestinal obstruction. It is commonly seen in severely malnourished patients presenting with repeated episodes of vomiting. We report a case of SMA syndrome in a 3 years old male child provisionally diagnosed as chronic gastric volvulus with severe acute malnutrition. The diagnosis of SMA syndrome was confirmed on abdominal exploration. SMA syndrome is a rare case of intestinal obstruction in paediatric age group. Chronic malnutrition is one of the common causes of this entity. There should be a high index of suspicion for this syndrome when we encounter a child with severe malnutrition and recurrent vomiting.

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

Journal of Eating Disorders ◽

10.1186/s40337-021-00436-2 ◽

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.

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

Gastroenterology Research and Practice ◽

10.1155/2018/1937416 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 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.

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Hypothalamic Germinoma Masquerading as Superior Mesenteric Artery (SMA) Syndrome

Endocrine Practice ◽

10.4158/ep12218.cr ◽

2013 ◽

Vol 19 (1) ◽

pp. e29-e34 ◽

Cited By ~ 1

Author(s):

Shireene Vethakkan ◽

Yogeswari Venugopal ◽

Alexander Tan ◽

Sharmila Paramasivam ◽

Jeyakantha Ratnasingam ◽

...

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Sma Syndrome

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Superior Mesenteric Artery Syndrome with Abdominal Compartment Syndrome

Case Reports in Emergency Medicine ◽

10.1155/2016/7809281 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Kevin Reece ◽

Rachel Day ◽

Janna Welch

Keyword(s):

Superior Mesenteric Artery ◽

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Mesenteric Artery ◽

Inferior Vena ◽

Vena Cava ◽

Exploratory Laparotomy ◽

Sensory Function ◽

Sma Syndrome ◽

Abdominal Compartment

Superior Mesenteric Artery (SMA) syndrome is a condition in which the duodenum becomes compressed between the SMA and the aorta, resulting in bowel obstruction which subsequently compresses surrounding structures. Pressure on the inferior vena cava (IVC) and aorta decreases cardiac output which compromises distal blood flow, resulting in abdominal compartment syndrome with ischemia and renal failure. A 15-year-old male with SMA syndrome presented with 12 hours of pain, a distended, rigid abdomen, mottled skin below the waist, and decreased motor and sensory function in the lower extremities. Exploratory laparotomy revealed ischemic small bowel and stomach with abdominal compartment syndrome. Despite decompression, the patient arrested from hyperkalemia following reperfusion.

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

Journal of Orthopaedic Surgery ◽

10.1177/2309499020945014 ◽

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.

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Intestinal Obstruction Secondary to Superior Mesenteric Artery Syndrome

Cirugía Española (English Edition) ◽

10.1016/j.cireng.2019.03.012 ◽

2019 ◽

Vol 97 (9) ◽

pp. 532

Author(s):

Irene Mirón Fernández ◽

Laura Romacho López ◽

Tania Díaz Antonio ◽

Julio Santoyo Santoyo

Keyword(s):

Intestinal Obstruction ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Superior Mesenteric Artery Syndrome

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Unusual Etiologies for Vascular Duodenal Compression Mimicking the Superior Mesenteric Artery (SMA) Syndrome: The SMA-Like Syndrome

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0039-1694833 ◽

2019 ◽

Vol 02 (02) ◽

pp. 140-146

Author(s):

Peter E. Dross ◽

Shawdon Molavi ◽

Alex Chan ◽

Rachael Latshaw ◽

Pankaj Chhabra

Keyword(s):

Superior Mesenteric Artery ◽

Diagnostic Criteria ◽

Mesenteric Artery ◽

Sma Syndrome

AbstractWe report a series of nine cases of unusual etiologies for vascular duodenal compression that do not meet the diagnostic criteria for superior mesenteric artery (SMA) syndrome and propose that “SMA-like syndrome” be used to classify these vascular duodenal compression cases.

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