Superior Mesenteric Artery Syndrome: An Unusual Cause Of Duodenal Obstruction (original) (raw)

Superior mesenteric artery syndrome as a rare cause of duodenal obstruction

Surgical Practice, 2007

Superior mesenteric artery syndrome is a rare cause of duodenal obstruction. The syndrome can present as acute small bowel obstruction or intermittent compression symptoms such as postprandial epigastric pain, fullness or vomiting. The obstruction is caused by compression of the third part of the duodenum against the posterior structures by the narrow-angled superior mesenteric artery. The diagnosis is easily confused with gastric outlet obstruction or proximal small bowel obstruction. A high index of clinical suspicion is crucial for diagnosis and computed tomography provides confirmatory evidence. We report two cases of superior mesenteric artery syndrome and a review of the literature for this condition.

Superior Mesenteric Artery Syndrome: A Forgotten Cause of Duodenal Obstruction

Cureus, 2020

Superior mesenteric artery (SMA) syndrome has been described in medical literature as a rare cause of duodenal occlusion. It has a varied presentation, with distressing gastrointestinal symptoms such as nausea, abdominal pain, and further weight loss. Several conditions contribute to duodenal obstruction in SMA syndrome. We present a case of SMA syndrome in a patient with malignant breast cancer who presented with sudden onset of severe nausea and voluminous vomiting. Various imaging studies revealed a distended proximal intestine with a transition point in the third part of the duodenum. The patient was managed conservatively with nasogastric decompression and fluid electrolyte management, leading to symptomatic relief.

A rare cause of duodenal obstruction: Superior mesenteric artery syndrome

International Journal of Case Reports and Images, 2015

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor.

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

International Surgery Journal, 2019

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 bowe...

A Remarkable Case of Superior Mesenteric Artery Syndrome

Journal of Medical Science And clinical Research, 2016

Superior mesenteric artery syndrome is a rare acquired disorder where the third part of duodenum is compromised between the superior mesenteric artery anteriorly and the aorta and lumbar spine posteriorly. We report an interesting case of a 17 year old asthenic female presenting with recurrent bouts of epigastric pain along with repeated episodes of vomiting. She was subjected to ultrasound examination of the abdomen and subsequent computerised tomography which revealed a dilated stomach, dilatation of first and second part of duodenum with compression of its third part between superior mesenteric artery and the aorta. A diagnosis of superior mesenteric artery syndrome was made. This was corroborated with surgical findings of extrinsic compression of third part of duodenum between superior mesenteric artery and the aorta.

Superior Mesenteric Artery Syndrome: Diagnosis and Management

PubMed, 2017

Superior mesenteric artery syndrome is a life-threatening rare acquired upper gastrointestinal disorder due to mechanical compression of third part of duodenum by the acute angulation of Superior mesenteric artery, leading to obstruction. Acute loss of intervening mesenteric fat as a result of a variety of debilitating conditions is believed to be the etiologic factor causing the reduced aortomesenteric angle. Abdominal CT angiography showed the dilatation of second part of duodenum and vascular compression of the proximal third part of the duodenum between the aorta and superior mesenteric artery. We report a case of 15 year old young boy who presented with recurrent postprandial pain in the epigastric region, accompanied by epigastric fullness, nausea, postprandial bilious vomiting and weight loss. When conservative measures were ineffective, laparoscopic retrocolic duodenojejunostomy, side to side anastomosis, was performed in the patient to relieve the obstruction. This case report is unusual as it is concerned with the description of a rare disease entity and its radiological appearances for early preoperative diagnosis, better understanding and management of the disease are discussed in the pertinent light of literature.

Superior mesenteric artery syndrome and its ramifications

CMIG Extra: Cases

The superior mesenteric artery extends anteriorly and inferiorly off the aorta at the level of the first lumbar vertebrae. The duodenal sweep and left renal vein are located in the aorto-mesenteric angle space. A decrease from the normal angle may compress these two structures. The case presented here discusses a unique patient with significant compression of the third portion of the duodenum and possible enlargement of the proximal left renal vein as these two structures cross the aorto-mesenteric angle.

Superior Mesenteric Artery Syndrome: A Rare Mimic of Common Causes of Upper Gastrointestinal Obstruction

Euroasian Journal of Hepato-Gastroenterology, 2014

A 61-year-old man presented with symptoms of upper gastrointestinal (GI) obstruction, such as postprandial upper abdominal pain, vomiting and weight loss. He was operated for a perforated duodenal ulcer 12 years back. On physical examination, there was mild tenderness over epigastrium. Blood examinations were normal. Typical imaging findings of superior mesenteric artery (SMA) syndrome were demonstrated. Ultrasound examination revealed gastric and duodenal dilatation (Fig. 1). Multidetector computed tomography (MDCT) with multiplanar reconstruction (MPR) revealed aortomesenteric angle (AMA) of <20° and aortomesenteric distance (AMD) from 5 to 8 mm. There was abrupt narrowing of 3rd part of duodenum with dilatation of stomach and proximal duodenum (up to 2nd part) (Figs 2 to 4). Endoscopy revealed two minor benign peptic ulcers but no other cause of duodenal obstruction. Diagnosis of SMA

Laparoscopic Management of Duodenal Obstruction Resulting From Superior Mesenteric Artery Syndrome

JAMA Surgery, 2014

uperior mesenteric artery (SMA) syndrome is a rare disease that causes compression of the third portion of the duodenum. Current definitions focus on the mechanical obstruction secondary to compression of the third portion of the duodenum by the SMA anteriorly and the aorta and vertebral column posteriorly. 1 The duodenal compression often manifests as a sense of fullness in the epigastrium, postprandial abdominal pain, early satiety, and intermittent emesis. 1-7 Although nonoperative medical management is often attempted as the initial treatment modality, surgical intervention can be required for bypass of the obstruction. 2 Open duodenojejunostomy remains the standard operation for SMA syndrome. 1-5 A minimally invasive approach to treating SMA syndrome, developed from bariatric surgery techniques, now offers an alternative to traditional laparotomy.