scholarly journals Superior mesenteric artery syndrome causing gastric outlet obstruction: A myth in acute abdomen

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Norfaidhi Akram MN ◽  
◽  
Husni S ◽  
Sarmukh S ◽  
Azmi H ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Acute Abdomen ◽  
Gastric Outlet Obstruction ◽  
Mesenteric Artery ◽  
Treatment Options ◽  
Outlet Obstruction ◽  
Acute Onset ◽  
Superior Mesenteric Artery Syndrome ◽  
Vascular Compression ◽  
Sma Syndrome

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.

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

scholarly journals Facts and fantasies about superior mesenteric artery syndrome: an unusual cause of intestinal obstruction

2019 ◽  
Vol 6 (7) ◽  
pp. 2591
Author(s):  
Swapnil Singh Kushwaha ◽  
Shikha Goja
Keyword(s):  
Intestinal Obstruction ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Early Recognition ◽  
Recurrent Abdominal Pain ◽  
Favourable Outcome ◽  
Vascular Compression ◽  
Fatty Tissue ◽  
Diagnostic Dilemma ◽  
Sma Syndrome

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.

scholarly journals Case Report of a Superior Mesenteric Artery Syndrome in an Autistic Patient with Schizophrenia

2021 ◽  
pp. 21
Author(s):  
Lee Mem Tim ◽  
Bernard Ho Kar Eng ◽  
Sentilnathan Subramaniam ◽  
Harivinthan Sellappan
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Ct Scan ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Superior Mesenteric Artery Syndrome ◽  
Autistic Patient ◽  
Gastrointestinal Obstruction ◽  
Sma Syndrome ◽  
Upper Gastrointestinal

Introduction: Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction. Diagnosis is confirmed via computed tomography (CT) scan showing acute angulation at the origin of superior mesenteric artery compressing on the duodenum causing proximal dilatation of the second part of duodenum.

A CASE REPORT : A CASE OF SUPERIOR MESENTERIC ARTERY SYNDROME

2021 ◽  
pp. 7-7
Author(s):  
Madhav Santoki ◽  
Alpesh Amin
Keyword(s):  
Case Report ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Duodenal Obstruction ◽  
Superior Mesenteric Artery Syndrome ◽  
Clinical Entity ◽  
The Third ◽  
Sma Syndrome ◽  
Transverse Portion

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%.

Laparoscopic Duodenojejunostomy for Superior Mesenteric Artery Syndrome

2010 ◽  
Vol 76 (3) ◽  
pp. 321-324 ◽  
Author(s):  
Gitonga Munene ◽  
Michel Knab ◽  
Bhanot Parag
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Critical Appraisal ◽  
Case Reports ◽  
Case Series ◽  
Standard Of Care ◽  
Morbidity Rate ◽  
Vascular Compression ◽  
Sma Syndrome ◽  
Uncommon Condition

Superior mesenteric artery (SMA) syndrome is an uncommon condition of duodenal obstruction secondary to extrinsic vascular compression. With the advent of laparoscopy, an emerging option to treat SMA syndrome is laparoscopic duodenojejunostomy. Given the rarity of the condition a critical appraisal of the effectiveness and safety of this relatively new surgical option has not been performed. Here we present a case report and a critical review of all published reports of laparoscopic duodenojejunostomy. A systematic literature review of all published reports describing laparoscopic duodenojejunostomy was performed by querying the MEDLINE database using keywords: laparoscopic duodenojejunostomy and SMA syndrome. Nine articles were reviewed which were mainly case reports and case series (level 5 data), reporting on a total of 13 patients, with 32 per cent of the patients being male and 68 per cent female. The diagnosis was established preoperatively in 62 per cent of the cases, the length of stay was 4.5 days, the morbidity rate was 7 per cent, and no mortalities were reported. The operation was considered successful in 100 per cent of patients. Laparoscopic duodenojejunostomy seems to be a safe and effective treatment for patients with SMA syndrome, but more data is required to recommend this operative option as the standard of care.

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