Abstract
Superior mesenteric artery (SMA) syndrome is an uncommon cause of gastrointestinal tract obstruction which is accompanied with epigastric pain and vomiting. Normally, the angle created by the aorta and the SMA is between 45 - 60 degrees. Any factor that narrows this aorto-mesenteric angle to less than 25 degrees can result in entrapment and compression of the third part of the duodenum and leading to the SMA syndrome.
This paper describes our experience in the diagnosis and management of 5 cases of this rare entity in our tertiary care hospital.
Keywords: Superior Mesenteric Artery Syndrome, SMA, narrow aorto-mesenteric angle, Mega duodenum.
References
- Rokitansky C: Handbuch der pathologischen Anatomie, ed 1. Wien, Braunmuller & Seidel 1842, vol 3, p187.
- Wilkie DPD: Chronic duodenal ileus. Am J Med Sci 1927;173:643-649.
- Barner HB, Sherman CD., Jr Vascular compression of the Duodenum. Int Abstr Surg. 1963 Aug;117:103-118.
- Welsch T, Buchler MW, Kienle P: Recalling Superior Mesenteric Artery Syndrome. Dig Surg. 2007; 24(3):149-56
- Agrawal GA, Johnson PT, Fishman EK: Multidetector row CT of superior mesenteric artery syndrome. J Clin Gastroenterol. 2007 Jan;41(1):62-5.
- Lowell S. Goin, Stefan P. Wilk. Intermittent Arteriomesenteric Occulusion of the Duodenum. Radiology (Nov 1, 1956) 67(5):729-737.
- Ylinen P, Kinnunen J, Hockerstedt K. J Clin Gastroenterol. 1989 Aug; 11(4):386-91.
- C. S. Limaye, S. P. Karande, S. P. Aher, and K. A. Pati, “Superior mesenteric artery syndrome secondary to tuberculosis induced cachexia,” The Journal of the Association of Physicians of India, vol. 59, pp. 670–671, 2011.
- M.-C. Wu, I.-C. Wu, J.-Y. Wu, D.-C. Wu, and W.-M. Wang, “Superior mesenteric artery syndrome in a diabetic patient with acute weight loss,” World Journal of Gastroenterology, vol. 15, no. 47, pp. 6004–6006, 2009.
- C. W. Lee, M. I. Park, S. J. Park et al., “A case of superior mesenteric artery syndrome caused by anorexia nervosa,” The Korean Journal of Gastroenterology, vol. 58, no. 5, pp. 280–283, 2011.
- J. L. Falcone and K. O. Garrett, “Superior mesenteric artery syndrome after blunt abdominal trauma: a case report,” Vascular and Endovascular Surgery, vol. 44, no. 5, pp. 410–412, 2010.
- T. J. Lescher, K. R. Sirinek, and B. A. Pruitt Jr., “Superior mesenteric artery syndrome in thermally injured patients,” Journal of Trauma, vol. 19, no. 8, pp. 567–571, 1979
- Altiok H, Lubicky JP, DeWald CJ, Herman JE: The superior mesenteric artery syndrome in patients with spinal deformity. Spine 2005;30:2164-2170.
- D. Goitein, D. J. Gagné, P. K. Papasavas et al., “Superior mesenteric artery syndrome after laparoscopic Roux-en-Y gastric bypass for morbid obesity,” Obesity Surgery, 2004 vol. 14, no. 7, pp. 1008–1011.
- M. Sturtevant, “Megaduodenum and duodenal obstruction. Criteria for diagnosis,” Radiology, vol. 33, no. 2, pp. 185–188, 1939.
- C. M. Townsend and J. J. Naoum, “Vascular compression of the duodenum,” in Mastery of Surgery, J. E. Fischer, Ed., pp. 955–961, Lippincott Williams & Wilkins, 5th edition, 2007.
- L. B. Cohen, S. P. Field, and D. B. Sachar, “The superior mesenteric artery syndrome. The disease that isn't, or is it?” Journal of Clinical Gastroenterology, vol. 7, no. 2, pp. 113–116, 1985.
- W. Z. Massoud, “Laparoscopic management of superior mesenteric artery syndrome,” International Surgery, vol. 80, no. 4, pp. 322–327, 1995.
Corresponding Author
Dr Chaithanya Babu Bogarapu
Assistant Professor of Surgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh – 530001, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i7.116
