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Díaz-Martínez J, Hizojo-Aloé FT, Rivera-Chávez RJ, González-Hernández NA. Misdiagnosed superior mesenteric artery syndrome due to diabetic gastroparesis. Case report and literature review. Int J Surg Case Rep 2024; 117:109543. [PMID: 38513416 DOI: 10.1016/j.ijscr.2024.109543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Superior mesenteric artery syndrome (SMAS) is a rare cause of upper intestinal obstruction. This occurs due to duodenal compression between the superior mesenteric artery and the aorta. Anatomical alterations, eating disorders, after some surgical procedures, and trauma are frequent causes of this rare syndrome. Diabetes is a highly prevalent disease that can cause gastroparesis in up to 12 %. Its association with SMAS is extremely rare and challenging to identify. CASE PRESENTATION A 32-year-old man experienced nausea and vomiting after diagnosis and treatment for type II diabetes. He was treated for diabetic gastroparesis for 2 years without improvement until he lost 40 kg of weight. After imaging studies, a distance between the superior mesenteric artery and the aorta of 5.3 mm and an angle of 17 degrees were detected, corroborating the diagnosis of SMAS syndrome. Due to medical failure, surgical treatment via duodenojejunostomy was performed. DISCUSSION Diabetes is a very prevalent disease in the world population that can cause gastrointestinal symptoms. In our patient, diabetic gastroparesis delayed the diagnosis of SMAS until severe symptoms of upper intestinal obstruction and significant weight loss occurred. In our patient, due to medical failure, surgical treatment significantly improved his symptoms and stopped his weight loss. CONCLUSION Superior mesenteric artery syndrome is a rare syndrome, and challenging to differentiate from diabetic gastroparesis. Delays in management may result in excessive weight loss. Surgical treatment can improve symptoms and weight loss.
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Affiliation(s)
- Jair Díaz-Martínez
- General Surgery Service, High Specialty Regional Hospital "Centenario de la Revolución Mexicana" ISSSTE, Morelos, México.
| | - Francisco Tomás Hizojo-Aloé
- General Surgery Service, High Specialty Regional Hospital "Centenario de la Revolución Mexicana" ISSSTE, Morelos, México
| | - Renata Jimena Rivera-Chávez
- General Surgery Service, High Specialty Regional Hospital "Centenario de la Revolución Mexicana" ISSSTE, Morelos, México
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Parr KM, Damjanovic IG, Bale LSW, Damjanovic MM. A case of significant loss of mesenteric fat: Educational and clinical relevance. Morphologie 2024; 108:100771. [PMID: 38458142 DOI: 10.1016/j.morpho.2024.100771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/10/2024]
Affiliation(s)
- K M Parr
- Queen's University, Department of Biomedical and Molecular Sciences, 18 Stuart Street, Kingston, K7L 3N6 Ontario, Canada
| | - I G Damjanovic
- Queen's University, Department of Biomedical and Molecular Sciences, 18 Stuart Street, Kingston, K7L 3N6 Ontario, Canada
| | - L S W Bale
- Queen's University, Department of Biomedical and Molecular Sciences, 18 Stuart Street, Kingston, K7L 3N6 Ontario, Canada
| | - Madeline M Damjanovic
- Queen's University, Department of Biomedical and Molecular Sciences, 18 Stuart Street, Kingston, K7L 3N6 Ontario, Canada.
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Hasegawa N, Oka A, Awoniyi M, Yoshida Y, Tobita H, Ishimura N, Ishihara S. Dynamic ultrasonography for optimizing treatment position in superior mesenteric artery syndrome: Two case reports and review of literature. World J Gastroenterol 2024; 30:499-508. [PMID: 38414592 PMCID: PMC10895595 DOI: 10.3748/wjg.v30.i5.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta (SMA-Ao). Although the left lateral recumbent position is considered effective in the treatment of SMA syndrome, individual variations in the optimal patient position have been noted. In this report, we present two elderly cases of SMA syndrome that exhibited rapid recovery due to ultrasonographic dynamic evaluation of the optimal position for each patient. CASE SUMMARY Case 1: A 90-year-old man with nausea and vomiting. Following diagnosis of SMA syndrome by computed tomography (CT), ultrasonography (US) revealed the SMA-Ao distance in the supine position (4 mm), which slightly improved in the lateral position (5.7-7.0 mm) without the passage of duodenal contents. However, in the sitting position, the SMA-Ao distance was increased to 15 mm accompanied by improved content passage. Additionally, US indicated enhanced passage upon abdominal massage on the right side. By day 2, the patient could eat comfortably with the optimal position and massage. Case 2: An 87-year-old woman with vomiting. After the diagnosis of SMA syndrome and aspiration pneumonia by CT, dynamic US confirmed the optimal position (SMA-Ao distance was improved to 7 mm in forward-bent position, whereas it remained at 5 mm in the supine position). By day 7 when her pneumonia recovered, she could eat with the optimal position. CONCLUSION The optimal position for SMA syndrome varies among individuals. Dynamic US appears to be a valuable tool in improving patient outcomes.
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Affiliation(s)
- Nobuaki Hasegawa
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Muyiwa Awoniyi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Hepatology Section, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Yuri Yoshida
- Clinical Laboratory Division, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Hiroshi Tobita
- Division of Hepatology, Shimane University Hospital, Izumo 693-8501, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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Lee IC. Superior mesenteric artery syndrome with or without the nutcracker phenomenon? Anterior nutcracker anatomical associated diseases. Asian J Surg 2024:S1015-9584(24)00030-7. [PMID: 38233274 DOI: 10.1016/j.asjsur.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/05/2024] [Indexed: 01/19/2024] Open
Affiliation(s)
- I-Chin Lee
- Department of Surgery, Jiahui International Hospital, Jiahui Health, Shanghai, China.
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Tang J, Zhang M, Zhou Y, Cao G, Li S, Zhang X, Tang S. Laparoscopic lateral duodenojejunostomy for pediatric superior mesenteric artery compression syndrome: a cohort retrospective study. BMC Surg 2023; 23:365. [PMID: 38049799 PMCID: PMC10694871 DOI: 10.1186/s12893-023-02274-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023] Open
Abstract
PURPOSE There are only a few case reports of laparoscopic lateral duodenojejunostomy (LLDJ) in children with Wilkie's syndrome, also known as superior mesenteric artery compression syndrome (SMAS). We aimed to describe our laparoscopic technique and evaluate its outcomes for SMAS in children. METHODS From January 2013 to May 2021, SMAS children who received LLDJ were included. The procedure was carried out utilizing the four-trocar technique. The elevation of the transverse colon allows good exposure of the dilated and bulging second and third sections of the duodenum. Using a linear stapler, we established a lateral anastomosis connecting the proximal jejunum with the third part of the duodenum. Following that, a running suture was used to intracorporeally close the common enterotomy. Clinical data on patients was collected for analysis. The demographics, diagnostic findings, and postoperative outcomes were analyzed retrospectively. RESULTS We retrospectively analyzed 9 SMAS patients (6 females and 3 males) who underwent LLDJ, aged between 7 and 17 years old. The mean operative time was 118.4 ± 16.5 min and the mean estimated blood loss was 5.6 ± 1.4 ml. There were no conversion, intraoperative complications or immediate postoperative complications. The mean postoperative hospital stay was 6.8 ± 1.9 days and the mean follow-up time was 5.4 ± 3.0 years. During follow-up, seven patients (77.8%) experienced complete recovery of symptoms prior to surgery. One patient (11.1%) still had mild vomiting, which resolved with medication. Another patient (11.1%) developed psychological-induced nausea, which significantly improved after treatment with education, training and diet management. CONCLUSIONS LLDJ represents a feasible and safe treatment option for SMAS in well-selected children. Further evaluation with more cases and case-control studies is required for the real benefits.
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Affiliation(s)
- Jingfeng Tang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengxin Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Zhou
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoqing Cao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaotao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Caterine S, Patil NS, Takrouri H, Issenman RM, Stein NR, Donnellan J, Yikilmaz A. Understanding the diagnosis of superior mesenteric artery syndrome: analysis of the location of duodenal impression on upper gastrointestinal studies. Pediatr Radiol 2023; 53:2633-2641. [PMID: 37837457 PMCID: PMC10697883 DOI: 10.1007/s00247-023-05782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Upper gastrointestinal (GI) contrast studies are frequently requested to aid superior mesenteric artery syndrome diagnosis, a rare entity. Compression of the third duodenal part is expected to be mid-to-left of the midline where the superior mesenteric artery arises from the aorta; however, a duodenal impression to the right of the midline due to normal anatomic impression by the inferior vena cava (IVC) is often encountered and frequently misdiagnosed. OBJECTIVE The purpose of this study was to determine the frequencies of (1) normal right-of-midline duodenal impressions and (2) mid-to-left of midline compressions in upper GI studies in a tertiary pediatric referral center. MATERIALS AND METHODS All upper GI studies performed at our institution over 2 years were retrospectively evaluated to determine whether the duodenum had vertical duodenal impression to the right of the vertebral midline, mid-to-left of the vertebral midline, or no identifiable duodenal impression at all. RESULTS In total, 538 upper GI studies were included in this analysis. A total of 275 male and 247 female patients between 0 and 17 years of age (median: 6 years, range: 1 month-17 years) were included. Of 538 total upper GI studies, there were 240 studies (44.6%) with a right-of-midline impression. There were only 10 studies (1.9%) with a mid-to-left of midline compression, and 9/10 also showed a concurrent right-sided impression sign. CONCLUSION Right-of-midline duodenal impression is a normal anatomic finding caused by the IVC and should not be confused with superior mesenteric artery syndrome. In the presence of an appropriate clinical context, proximal duodenal dilation, "to-and-fro" motion of contrast, and duodenal impression at mid-to-left of midline, a diagnosis of superior mesenteric artery syndrome should be considered.
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Affiliation(s)
- Scott Caterine
- Department of Pediatric Radiology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Nikhil S Patil
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Heba Takrouri
- Department of Pediatric Radiology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Robert M Issenman
- Department of Pediatric Gastroenterology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Nina R Stein
- Department of Pediatric Radiology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - John Donnellan
- Department of Pediatric Radiology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Ali Yikilmaz
- Department of Pediatric Radiology, McMaster Children's Hospital, Hamilton, ON, Canada.
- Diagnostic Imaging, Hamilton Health Sciences, McMaster Children's Hospital, Room 2S28, 1200 Main St. West, Hamilton, ON, L8N 3Z5, Canada.
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Ohyama S, Kotani T, Iijima Y, Okuwaki S, Sunami T, Iwata S, Sakuma T, Ogata Y, Akazawa T, Inage K, Shiga Y, Minami S, Ohtori S. Incidence and Potential Risk Factors of Superior Mesenteric Artery Syndrome After Spinal Corrective Surgery in Patients with Adult Spinal Deformity. World Neurosurg 2023; 180:e591-e598. [PMID: 37805127 DOI: 10.1016/j.wneu.2023.09.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE This study aimed to determine the incidence and potential risk factors of superior mesenteric artery syndrome (SMAS) after corrective spinal surgery in patients with adult spinal deformity (ASD). METHODS In total, 102 patients (67.6 ± 8.4 years; 8 male/94 female; body mass index (BMI); 22.4 ± 3.6 kg/m2) with ASD treated by spinal correction surgery were enrolled. Preoperative and postoperative spinal parameters, including thoracolumbar kyphosis (TLK: T10-L2) and upper lumbar lordosis (ULL: L1-L4) were measured. To evaluate the potential risk factors of SMAS, the angle and the distance between the superior mesenteric artery and aorta, the aortomesenteric angle (AMA) and aortomesenteric distance (AMD), were evaluated pre- and postoperatively. Based on the postoperative AMA, AMD, and abdominal symptoms, the patients were diagnosed with SMAS. Correlations between demographic data or spinal parameters and AMA and AMD were assessed. RESULTS Two (2.0%) patients were diagnosed with SMAS. Postoperative TLK significantly correlated with postoperative AMA (P = 0.013, 0.046). Postoperative ULL was significantly correlated with postoperative AMD (β = -0.27; P = 0.014). CONCLUSION The incidence of SMAS after corrective spinal surgery in patients with ASD was 2.0%. Postoperative smaller TLK and greater ULL can be risk factors for developing SMAS. Spine surgeons should avoid overcorrection of the upper lumbar spine in the sagittal plane to prevent SMAS.
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Affiliation(s)
- Shuhei Ohyama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan.
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Shun Okuwaki
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Takahiro Sunami
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Shuhei Iwata
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Yosuke Ogata
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsutomu Akazawa
- Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Ahn TY, Han JB, Bae JY, Woo SH. Superior mesenteric artery syndrome in a patient with fibrodysplasia ossificans progressiva. Bone Rep 2023; 19:101702. [PMID: 37520933 PMCID: PMC10382279 DOI: 10.1016/j.bonr.2023.101702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
An 18-year-old boy with fibrodysplasia ossificans progressiva lost weight at an accelerated rate due to gastrointestinal symptoms, resulting in a weight loss of 36 kg in 1 year. His first outpatient abdominal computed tomography (CT) result was unremarkable. Since the patient had biliary vomiting during hospitalization, his CT was reexamined, and the superior mesenteric artery syndrome diagnosis was confirmed. Thus, clinicians must consider superior mesenteric artery syndrome when presented with weight loss.
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Affiliation(s)
- Tae Young Ahn
- Department of Orthopedic Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea
| | - Jung Bum Han
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea
| | - Jung Yun Bae
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea
| | - Seung Hun Woo
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea
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Singh S, Contrucci AL. Superior mesenteric artery syndrome and anorexia nervosa: a case report. J Med Case Rep 2023; 17:459. [PMID: 37924161 PMCID: PMC10625252 DOI: 10.1186/s13256-023-04168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/09/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Superior mesenteric artery (SMA) syndrome is an underdiagnosed complication in anorexia nervosa (AN) patients, which results from weight loss-induced atrophy of the mesenteric fat pad, causing compression of the third part of the duodenum. SMA syndrome can be life-threatening as its nonspecific symptomatology often results in a delayed diagnosis. It is a rare condition, but its true prevalence may be higher than the reported numbers. A history of persistent nausea and vomiting after oral intake and weight loss in AN should raise suspicion about this diagnosis, as weight loss is the most significant factor in this diagnosis. Other high-risk factors include rapid, extreme weight loss, anatomical abnormalities, or a history of prior abdominal or spinal surgeries. CASE PRESENTATION The patient presented in this report was a 26-year-old Caucasian female with a history of severe enduring anorexia nervosa. This patient suffered from an insidious case of SMA syndrome secondary to AN. This patient presented with vague symptoms of nausea and vomiting, persistent abdominal pain, and rapid weight loss. The patient was successfully treated but could have had a much different outcome if the diagnosis had been further delayed. CONCLUSIONS An awareness of SMA syndrome and its clinical presentation within similar populations can prevent complications and even fatalities that come with it.
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Affiliation(s)
- Shivani Singh
- Philadelphia College of Osteopathic Medicine, Suwanee, GA, USA.
| | - Ann L Contrucci
- Philadelphia College of Osteopathic Medicine, Suwanee, GA, USA
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Seo JH, Lee I, Choi S, Yang S, Kim YJ. Gastric Pneumatosis and Its Gastrofibroscopic Findings in Life-Threatening Superior Mesenteric Artery Syndrome Complicated by Anorexia Nervosa in a Child. Pediatr Gastroenterol Hepatol Nutr 2023; 26:284-289. [PMID: 37736219 PMCID: PMC10509018 DOI: 10.5223/pghn.2023.26.5.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/11/2023] [Accepted: 07/23/2023] [Indexed: 09/23/2023] Open
Abstract
A 14-year-old girl was admitted to the emergency department for excessive bile-containing vomiting and severe abdominal pain. She had been healthy until she intentionally lost 25 kg over a 6-month period. Thick, bloody bile-mixed food particles were drained from the stomach through a nasogastric tube. Abdominal computed tomography revealed huge stomach dilatation with extensive gastric pneumatosis, possible near rupture, acute pancreatitis, and a very narrow third of the duodenum, indicating superior mesenteric syndrome. Gastrofibroscopy revealed multiple hemorrhagic ulcers and numerous bead-like cystic lesions in the stomach. Laboratory examination results were notable for severe deficiencies in critical nutrients, including iron, zinc, proteins, and prealbumin, as well as undernutrition-associated endocrine complications such as hypothyroidism and hypogonadotropic hypogonadism. Excessive vomiting ceased after the endoscopic removal of stagnant gastric contents. Gastric pneumatosis improved after 3 days of supportive care.
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Affiliation(s)
- Jeong Ho Seo
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Inwook Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Saehan Choi
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Seung Yang
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Joo Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
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Abstract
BACKGROUND Superior mesenteric artery syndrome (SMAS), also known as Wilkie's syndrome, is a rare disease that mainly presents as intestinal obstruction with a variable incidence ranging from 0.013 to 0.3% (Salehzadeh et al. in Case Rep Gastrointest Med, 2019, 10.1155/2019/3458601). In this syndrome, the third part of the duodenum, located between the abdominal aorta and the superior mesenteric artery, is wholly or partially obstructed (Mosalli et al. in J Pediatr Surg 46:e29-31, 2011). Case presentation An 8-years-old Arabian male patient was admitted to the gastrointestinal department at the pediatric hospital in Damascus, Syria, with complaints of chronic abdominal pain and periodic vomiting since he was two years old. At the age of Seven, he was diagnosed with appendicitis, and after two months of persistent symptoms, he was diagnosed with an umbilical hernia. Finally, after a long time of suffering, he was diagnosed with SMAS and underwent a successful surgical operation. After 3 months of follow-up, he was in good health with no symptoms. CONCLUSION Whenever a patient complains of vomiting and chronic abdominal pain, intestinal obstruction is suspected, Common differential diagnoses were excluded and the cause is anonymous, we should consider superior mesenteric artery syndrome.
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Affiliation(s)
- Ayah Aldagher
- Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Rodaina Almasri
- Division of Gastroenterology, Pediatric University Hospital, Damascus, Syria
| | - Jaber Mahmoud
- Division of Gastroenterology, Pediatric University Hospital, Damascus, Syria
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Oka A, Awoniyi M, Hasegawa N, Yoshida Y, Tobita H, Ishimura N, Ishihara S. Superior mesenteric artery syndrome: Diagnosis and management. World J Clin Cases 2023; 11:3369-3384. [PMID: 37383896 PMCID: PMC10294176 DOI: 10.12998/wjcc.v11.i15.3369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/13/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
Superior mesenteric artery (SMA) syndrome (also known as Wilkie's syndrome, cast syndrome, or aorto-mesenteric compass syndrome) is an obstruction of the duodenum caused by extrinsic compression between the SMA and the aorta. The median age of patients is 23 years old (range 0-91 years old) and predominant in females over males with a ratio of 3:2. The symptoms are variable, consisting of postprandial abdominal pain, nausea and vomiting, early satiety, anorexia, and weight loss and can mimic anorexia nervosa or functional dyspepsia. Because recurrent vomiting leads to aspiration pneumonia or respiratory depression via metabolic alkalosis, early diagnosis is required. The useful diagnostic modalities are computed tomography as a standard tool and ultrasonography, which has advantages in safety and capability of real-time assessments of SMA mobility and duodenum passage. The initial treatment is usually conservative, including postural change, gastroduodenal decompression, and nutrient management (success rates: 70%-80%). If conservative therapy fails, surgical treatment (i.e., laparoscopic duodenojejunostomy) is recommended (success rates: 80%-100%).
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Affiliation(s)
- Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Muyiwa Awoniyi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Hepatology Section, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Nobuaki Hasegawa
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yuri Yoshida
- Clinical Laboratory Division, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Hiroshi Tobita
- Division of Hepatology, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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Asbah M, Shrateh ON, Musleh A, Abbadi K, Nofal M, Tarifi S. Superior mesenteric artery syndrome in a 30-year-old male patient: A case report and literature review. Int J Surg Case Rep 2023; 106:108267. [PMID: 37120897 PMCID: PMC10172887 DOI: 10.1016/j.ijscr.2023.108267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Due to a decrease in the aortomesenteric angle, the third section of the duodenum can become acutely or chronically compressed in the superior mesenteric artery syndrome (SMAS). CASE PRESENTATION A 31-year-old male patient complained of one-year-long recurrent postprandial abdominal pain, periumbilical, intermittent, and colicky. The pain increased in severity in the last 4 months and was relieved only with self-induced vomiting and partially with the knee-to-chest position. A CT scan was done and is most consistent with superior mesenteric artery syndrome. The patient was admitted to the operating room and underwent a successful laparoscopic duodenectomy of the third part of duodenum followed by duodenojejunostomy. CLINICAL DISCUSSION When conservative therapy fails, an open duodenojejunostomy is traditionally advised. A less invasive option that has been documented in up to 10 cases is laparoscopic duodenojejunostomy. We discuss the research on this issue and demonstrate our surgical method on one patient. CONCLUSION Even if there has been just a modest amount of weight loss, SMAS should be taken into account whenever a sudden observation of gastrointestinal obstruction symptoms is noted in patients with susceptible conditions such as low body weight.
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Affiliation(s)
- Malvina Asbah
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | - Asil Musleh
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Khaled Abbadi
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Mohammed Nofal
- Department of Radiology, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Sulaiman Tarifi
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
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14
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Jin S, Zhou H, Li W. Nursing of a lactating patient with superior mesenteric artery syndrome: a case report. J Int Med Res 2023; 51:3000605231157198. [PMID: 36879479 PMCID: PMC9996728 DOI: 10.1177/03000605231157198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Superior mesenteric artery syndrome (SMAS) involves duodenal obstruction caused by compression of the horizontal section of the duodenum between the superior mesenteric artery and abdominal aorta. Here, the experience of nursing a lactating patient with SMAS is summarized. Nursing care was performed according to a multiple therapy approach of treating the SMAS in addition to particular psychological factors that may be present during lactation. The patient underwent exploratory laparotomy under general anaesthesia, duodenal lysis, and abdominal aorta-superior mesenteric artery bypass with great saphenous vein grafting. The key nursing care included pain control, psychological care, positional therapy, observation and nursing care of fluid drainage and body fever, nutrition support and discharge health guidance. Through the above nursing methods, the patient was eventually able to return to a normal diet.
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Affiliation(s)
- Shanshan Jin
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hua Zhou
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenrui Li
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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15
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Xie J, Bai J, Zheng T, Shu J, Liu ML. Causes of epigastric pain and vomiting after laparoscopic-assisted radical right hemicolectomy - superior mesenteric artery syndrome. World J Gastrointest Surg 2023; 15:193-200. [PMID: 36896299 PMCID: PMC9988633 DOI: 10.4240/wjgs.v15.i2.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/19/2022] [Accepted: 01/10/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome (SMAS) is a rare condition causing functional obstruction of the third portion of the duodenum. Postoperative SMAS following laparoscopic-assisted radical right hemicolectomy is even less prevalent and can often be unrecognized by radiologists and clinicians.
AIM To analyze the clinical features, risk factors, and prevention of SMAS after laparoscopic-assisted radical right hemicolectomy.
METHODS We retrospectively analyzed clinical data of 256 patients undergoing laparoscopic-assisted radical right hemicolectomy in the Affiliated Hospital of Southwest Medical University from January 2019 to May 2022. The occurrence of SMAS and its countermeasures were evaluated. Among the 256 patients, SMAS was confirmed in six patients (2.3%) by postoperative clinical presentation and imaging features. All six patients were examined by enhanced computed tomography (CT) before and after surgery. Patients who developed SMAS after surgery were used as the experimental group. A simple random sampling method was used to select 20 patients who underwent surgery at the same time but did not develop SMAS and received preoperative abdominal enhanced CT as the control group. The angle and distance between the superior mesenteric artery and abdominal aorta were measured before and after surgery in the experimental group and before surgery in the control group. The preoperative body mass index (BMI) of the experimental group and the control group was calculated. The type of lymphadenectomy and surgical approach in the experimental and control groups were recorded. The differences in angle and distance were compared preoperatively and postoperatively in the experimental group compared. The differences in angle, distance, BMI, type of lymphadenectomy and surgical approach between the experimental and control groups were compared, and the diagnostic efficacy of the significant parameters was assessed using receiver operating characteristic curves.
RESULTS In the experimental group, the aortomesenteric angle and distance after surgery were significantly decreased than those before surgery (P < 0.05). The aortomesenteric angle, distance and BMI were significantly higher in the control group than in the experimental (P < 0.05). There was no significant difference in the type of lymphadenectomy and surgical approach between the two groups (P > 0.05).
CONCLUSION The small preoperative aortomesenteric angle and distance and low BMI may be important factors for the complication. Over-cleaning of lymph fatty tissues may also be associated with this complication.
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Affiliation(s)
- Juan Xie
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Jiao Bai
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ting Zheng
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ma-Li Liu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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16
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Shen Y, Yang T, Meng W, Wang Z. Surgical Intervention Could Relieve Obstruction-Related Symptoms of Refractory Superior Mesenteric Artery Syndrome: Long-Term Follow-up Results. Obes Surg 2023. [PMID: 36729364 DOI: 10.1007/s11695-023-06478-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Superior mesenteric artery syndrome (SMAS) is one of the rare causes of chronic duodenal obstruction. The aim of our study was to evaluate the outcomes of surgical management of refractory SMAS (Re-SMAS) in our institution during the last decade. MATERIALS AND METHODS Consecutive patients diagnosed as Re-SMAS and underwent surgical intervention were retrospectively enrolled. A modified Likert-scale-based questionnaire was used to quantify the symptoms of SMAS. The primary outcome was the increase of BMI and symptomatic relief after surgery. RESULTS From January 2010 to January 2020, 22 patients diagnosed with Re-SMAS and underwent surgery were included. Age distribution of included patients were < 19 (10/22, 45%), 19-45 (11/22, 50%), and > 45 (1/22, 5%). A significant BMI increase was recorded, [16.1 (14.6-23.7) kg/m2 vs 21.9 (15.6-29.5) kg/m2 before and after surgery, respectively, p < 0.001]. Up to 20 patients (20/22, 91%) reported symptomatic relief. The obstruction-related symptom score decreasing significantly (p < 0.001), with reported nausea, vomiting, and regurgitation incidences dropping from 77 to 41% (p = 0.031), 68 to 23% (p = 0.006), and 32 to 5% (p = 0.046), respectively. CONCLUSION Surgical interventions could relieve obstruction-related symptoms of Re-SMAS and promote weight gain. For patients who suffered from Re-SMAS and referred to surgeons mainly for obstruction-related symptoms, surgical intervention is recommended.
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17
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El Tawil C, Paquin R, Brody D. Superior mesenteric artery syndrome identified following bubble tea ingestion and duodenal impaction: a case report. CAN J EMERG MED 2023; 25:164-166. [PMID: 36471214 DOI: 10.1007/s43678-022-00424-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Chady El Tawil
- Division of Pediatric Emergency Medicine, Montreal Children's Hospital, Montreal, Canada.
| | - Raphael Paquin
- Division of Pediatric Emergency Medicine, Montreal Children's Hospital, Montreal, Canada
| | - Daniel Brody
- Division of Pediatric Emergency Medicine, Montreal Children's Hospital, Montreal, Canada
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18
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Jonas JP, Rössler F, Ghafoor S, Kobe A, Pfammatter T, Schlag C, Gutschow CA, Petrowsky H, Müller PC, Oberkofler CE. Surgical therapy of celiac axis and superior mesenteric artery syndrome. Langenbecks Arch Surg 2023; 408:59. [PMID: 36690823 PMCID: PMC9870837 DOI: 10.1007/s00423-023-02803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/20/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Compression syndromes of the celiac artery (CAS) or superior mesenteric artery (SMAS) are rare conditions that are difficult to diagnose; optimal treatment remains complex, and symptoms often persist after surgery. We aim to review the literature on surgical treatment and postoperative outcome in CAS and SMAS syndrome. METHODS A systematic literature review of medical literature databases on the surgical treatment of CAS and SMAS syndrome was performed from 2000 to 2022. Articles were included according to PROSPERO guidelines. The primary endpoint was the failure-to-treat rate, defined as persistence of symptoms at first follow-up. RESULTS Twenty-three studies on CAS (n = 548) and 11 on SMAS (n = 168) undergoing surgery were included. Failure-to-treat rate was 28% for CAS and 21% for SMAS. Intraoperative blood loss was 95 ml (0-217) and 31 ml (21-50), respectively, and conversion rate was 4% in CAS patients and 0% for SMAS. Major postoperative morbidity was 2% for each group, and mortality was described in 0% of CAS and 0.4% of SMAS patients. Median length of stay was 3 days (1-12) for CAS and 5 days (1-10) for SMAS patients. Consequently, 47% of CAS and 5% of SMAS patients underwent subsequent interventions for persisting symptoms. CONCLUSION Failure of surgical treatment was observed in up to every forth patient with a high rate of subsequent interventions. A thorough preoperative work-up with a careful patient selection is of paramount importance. Nevertheless, the surgical procedure was associated with a beneficial risk profile and can be performed minimally invasive.
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Affiliation(s)
- J P Jonas
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - F Rössler
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - S Ghafoor
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - A Kobe
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - T Pfammatter
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - C Schlag
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - C A Gutschow
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - H Petrowsky
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - P C Müller
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - C E Oberkofler
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland.
- Vivévis AG-Visceral, Tumor, Robotic Surgery, Clinic Hirslanden, Zurich, Switzerland.
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19
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Loi CM, Chen KH. Total gastric necrosis caused by massive gastric dilatation due to Superior Mesenteric Artery Syndrome. Asian J Surg 2022:S1015-9584(22)01713-4. [PMID: 36550012 DOI: 10.1016/j.asjsur.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
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20
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Barros LCTRD, Santos BMRTD, Ferreira GDSA, Gomes VMDS, Vieira LPB. Superior mesenteric artery syndrome in a patient with esophageal stenosis: A case report. World J Surg Proced 2022; 12:13-19. [DOI: 10.5412/wjsp.v12.i2.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/12/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome (SMAS) is a rare condition, characterized by duodenal obstruction caused by compression of its third part by the superior mesenteric artery (SMA). Most cases of SMAS are associated with weight loss, and the most frequent clinical manifestations are nausea, vomiting, postprandial fullness, and abdominal pain. Treatment of SMAS is usually conservative, consisting mainly of adequate nutritional support, but in refractory cases surgery may be necessary, with gastrojejunostomy and duodenojejunostomy being the most commonly performed procedures.
CASE SUMMARY We describe the case of a man in his forties with a pre-existing diagnosis of esophageal stricture due to sodium hydroxide ingestion, who suffered significant weight loss after replacement of his jejunostomy tube. He was admitted to the hospital due to pain and abdominal distension. A computerized tomography scan showed significant distension of the stomach and duodenum with narrowing of the duodenum at the point at which it is crossed by the superior mesenteric artery, thus establishing the diagnosis of SMAS. Due to the presence of the esophageal stricture, the patient was incapable of emesis; however, passage of a nasogastric tube for decompression was not possible. Considering the risk of gastric perforation due to distention, we opted for surgical treatment in the form of a surgical gastrojejunostomy after which he showed complete resolution of all symptoms and was discharged from the hospital 5 d after the procedure.
CONCLUSION Diagnosis of SMAS can be challenging in patients with esophageal stenosis, and risk of gastric perforation may preclude conservative treatment.
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Affiliation(s)
| | | | - Gustavo de Sousa Arantes Ferreira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Brasilia 70658-700, Distrito Federal, Brazil
- Department of General Surgery, Hospital Metropolitano Doutor Celio de Castro, Belo Horizonte 30620090, Minas Gerais, Brazil
| | - Vitoria Mikaelly da Silva Gomes
- Department of General Surgery, Hospital de Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte 31710350, Minas Gerais, Brazil
| | - Lorenna Paulinelli Bahia Vieira
- Department of General Surgery, Hospital de Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte 31710350, Minas Gerais, Brazil
- Department of General Surgery, Hospital Metropolitano Doutor Celio de Castro, Belo Horizonte 30620090, Minas Gerais, Brazil
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21
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Niasse A, Faye PM, Ndong A, Kuadjovi SR, Leye A, Diack ND, Gueye ML, Thiam O, Ndiaye M, Diouf A, Sarr ISS, Seye Y, Toure AO, Seck M, Cisse M, Dieng M. [ Superior mesenteric artery syndrome in gastric cancer: a case report]. Pan Afr Med J 2022; 42:217. [PMID: 36845233 PMCID: PMC9949278 DOI: 10.11604/pamj.2022.42.217.27281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/16/2020] [Indexed: 11/11/2022] Open
Abstract
Superior mesenteric artery syndrome or Wilkie syndrome is due to the compression of the third duodenum between the superior mesenteric artery and the aorta. It causes acute or chronic upper bowel occlusion. Abdominal CT scan facilitates the diagnosis. Severe malnutrition is its main etiological factor. Medical treatment can be based on aspiration of gastric contents and parenteral nutrition. If this fails, surgery is necessary. We here report the case of a 46-year-old patient, with a history of smoking, presenting with profuse postprandial bile and food vomiting. He had had weight loss of 7% over a period of 6 months. Upper GI endoscopy revealed non-stenotic antro-pyloric tumour mass. Histological examination showed poorly differentiated tubular gastric adenocarcinoma. Staging was without any peculiarity and allowed for the detection of superior mesenteric artery syndrome at an angle of 8°C. The patient received parenteral nutrition for 10 days, followed by inferior pole gastrectomy and gastrojejunal anastomosis (omega loop). The postoperative course was uneventful. Adjuvant chemotherapy was indicated.
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Affiliation(s)
- Abdou Niasse
- Service de Chirurgie, Centre Hospitalier National de Pikine, Dakar, Sénégal
| | - Papa Mamadou Faye
- Service de Chirurgie Générale, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar, Sénégal
| | - Abdourahmane Ndong
- Service de Chirurgie Générale, Hôpital Régional de Saint-Louis, Saint-Louis, Sénégal
| | | | - Abdoulaye Leye
- Service de Médecine Interne, Centre Hospitalier National de Pikine, Dakar, Sénégal
| | - Ngoné Diaba Diack
- Service de Médecine Interne, Centre Hospitalier National de Pikine, Dakar, Sénégal
| | - Mohamadou Lamine Gueye
- Service de Chirurgie Générale, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar, Sénégal
| | - Ousmane Thiam
- Service de Chirurgie Générale, Centre Hospitalier Universitaire Dalal Jamm, Dakar, Sénégal
| | - Mamadou Ndiaye
- Service de Chirurgie Générale, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar, Sénégal
| | - Ahmed Diouf
- Service de Chirurgie Générale, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar, Sénégal
| | | | - Yacine Seye
- Service de Chirurgie Générale, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar, Sénégal
| | - Alpha Oumar Toure
- Service de Chirurgie Générale, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar, Sénégal
| | - Mamadou Seck
- Service de Chirurgie Générale, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar, Sénégal
| | - Mamadou Cisse
- Service de Chirurgie Générale, Centre Hospitalier Universitaire Dalal Jamm, Dakar, Sénégal
| | - Madieng Dieng
- Service de Chirurgie Générale, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar, Sénégal
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22
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Du MC, Chen HY, Zhang YX, Zhang LB. Pica with superior mesenteric artery syndrome and nutcracker syndrome as imaging manifestation: A case report. Asian J Surg 2022; 45:2038-2039. [PMID: 35568610 DOI: 10.1016/j.asjsur.2022.04.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ming-Cheng Du
- Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Hong-Yu Chen
- Chengdu Wenjiang District People's Hospital, Pediatric Department, Chengdu, 611731, China
| | - Yi-Xian Zhang
- Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Li-Bing Zhang
- Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China, Chengdu, 611731, China.
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23
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Khan H, Al-Jabbari E, Shroff N, Barghash M, Shestopalov A, Bhargava P. Coexistence of superior mesenteric artery syndrome and nutcracker phenomenon. Radiol Case Rep 2022; 17:1927-1930. [PMID: 35401899 PMCID: PMC8987811 DOI: 10.1016/j.radcr.2022.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction. Nutcracker syndrome occurs as the result of external compression of the left renal vein. Although they share a similar pathophysiology, SMA and nutcracker syndrome occurring simultaneously is rare. In this case report, we discuss the pathophysiology and unique computed tomography findings in a 25-year-old female patient diagnosed with SMA syndrome who was also incidentally found to have a coexisting nutcracker phenomenon. Due to similar pathogenesis, radiologists should consider the possibility of coexistence of these rare syndromes in appropriate patients.
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Affiliation(s)
- Hasan Khan
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd., UTMB, Galveston, TX 77555, USA
| | - Esraa Al-Jabbari
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd., UTMB, Galveston, TX 77555, USA
| | - Neel Shroff
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd., UTMB, Galveston, TX 77555, USA
| | - Maggie Barghash
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd., UTMB, Galveston, TX 77555, USA
| | - Alexander Shestopalov
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd., UTMB, Galveston, TX 77555, USA
| | - Peeyush Bhargava
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd., UTMB, Galveston, TX 77555, USA
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24
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Miyadera K, Nakamichi S, Miyashita R, Shimizu M, Noro R, Kubota K, Seike M, Gemma A. Two cases of superior mesenteric artery syndrome during chemotherapy in patients with lung cancer. Int Cancer Conf J 2022; 11:124-8. [PMID: 35425694 DOI: 10.1007/s13691-022-00534-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/18/2022] [Indexed: 02/04/2023] Open
Abstract
Superior mesenteric artery (SMA) syndrome is a rare disease, characterized by the narrowing of the third portion of the duodenum between the aorta and SMA. The cause of the stenosis is a decrease in retroperitoneal fat between the aorta and SMA. In this report, we present two cases of SMA syndrome that occurred during chemotherapy for lung cancer. The first case was a 61-year-old male treated with nanoparticle albumin-bound-paclitaxel (nab-PTX) for lung adenocarcinoma. On day 23 of the first course of nab-PTX, he was admitted to our hospital due to vomiting and weight loss of 15.6 kg in 10 months. He was diagnosed with SMA syndrome through computed tomography, and drainage was performed using a nasogastric tube. Conservative treatment was successful, and the patient was able to continue therapy with nab-PTX. The second case was a 70-year-old male with epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer. He was admitted to our hospital due to vomiting and dizziness while receiving treatment with pembrolizumab, as well as weight loss of 14.6 kg in 6 months. He was diagnosed with SMA syndrome using computed tomography. Conservative treatment using a nasogastric tube led to improvement, and the patient was able to continue treatment with pembrolizumab after discharge. This is the first report of SMA syndrome in patients with lung cancer undergoing chemotherapy with nab-PTX or pembrolizumab. Late diagnosis and treatment render SMA syndrome a potentially fatal disease. Vomiting and weight loss during chemotherapy are known treatment-related side effects; in patients developing these adverse effects, the presence of SMA syndrome should be suspected and managed appropriately.
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25
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Yongqing N, Chen D, Rui L, Linlin L. The "Hand as Foot" teaching method in superior mesenteric artery syndrome. Asian J Surg 2021; 45:618-619. [PMID: 34895954 DOI: 10.1016/j.asjsur.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ni Yongqing
- Department of Pediatric, Inner Mongolia Medical University Hospital, HohhotNorth Street, Inner Mongolia, 010000, China
| | - Duan Chen
- Department of Pediatric, Inner Mongolia Medical University Hospital, HohhotNorth Street, Inner Mongolia, 010000, China.
| | - Liu Rui
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, HohhotNorth Street, Inner Mongolia, 010000, China
| | - Li Linlin
- Department of Pediatric, Inner Mongolia Medical University Hospital, HohhotNorth Street, Inner Mongolia, 010000, China
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26
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Mohtashami A, Chui JN, Law C, Cole-Clark D, Simon R. Postoperative superior mesenteric artery syndrome following appendicectomy: A case report. Int J Surg Case Rep 2021; 90:106629. [PMID: 34902698 PMCID: PMC8669364 DOI: 10.1016/j.ijscr.2021.106629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Superior mesenteric artery syndrome is a rare cause of proximal intestinal obstruction. It is caused by a narrow aortomesenteric angle resulting in external compression of the duodenum as it traverses between the abdominal aorta and the superior mesenteric artery. Presenting symptoms tend to be non-specific and aetiological risk factors for this syndrome remain subjects to debate. The lack of awareness for this phenomenon often results in a delayed diagnosis, yet it can predispose to potentially life-threatening complications. CASE PRESENTATION We describe an acquired case of SMA syndrome, in an 88-year old male who underwent an open appendicectomy 20 years prior. The patient presented with an 18-month history of progressive anorexia, weight loss, and intractable vomiting. After inconclusive initial investigations, an exploratory laparotomy demonstrated extensive postoperative adhesions, placing traction on the SMA through its ileocolic branch, resulting in acute angulation of the SMA and subsequent external duodenal compression. DISCUSSION This case illustrates the acute evolving presentation of gastric and duodenal obstruction associated with SMA syndrome, and the need to raise the index of suspicion for its diagnosis. In this case, it is postulated that SMA syndrome presented as a late complication of an open appendicectomy - A rare presentation for a rare disease. CONCLUSION SMA syndrome is an uncommon, but important differential for upper gastrointestinal obstruction. This case illustrates the challenges in the diagnosis of this rare clinical entity. Further study is warranted to understand the varied aetiology and optimal management for patients presenting with SMA syndrome.
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Affiliation(s)
- Ali Mohtashami
- Lismore Base Hospital, Lismore, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Juanita N Chui
- Lismore Base Hospital, Lismore, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia
| | - Cameron Law
- Lismore Base Hospital, Lismore, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia
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Abstract
Background Diagnostic delay of superior mesenteric artery syndrome (SMAS) is common due to its rarity and lack of index of clinical suspicion. Early diagnosis under suspicion is pivotal for adequate treatment. Present study aims to explore the endoscopic features for early decision to evaluate SMAS in children. Methods In case controlled observation study, the recruitment was limited to patients who had endoscopic finding I or finding 1 plus more as follows: a pulsating vertical or oblique band or slit like luminal narrowing of the third part of the duodenum without no expansion over one third during air insufflation for at least 15 s (finding I), a marked dilation of the duodenal first and second part during air insufflation at the third part of the duodenum (finding II), a bile mixed fluid collection (bile lake) in the stomach (finding III). SMAS was confirmed with UGI series or hypotonic duodenography in enrolled patients. We analyzed positive endoscopic findings related with SMAS. Results The enrolled 29 patients consisted of 18 (62.1%) with SMAS and 11 (37.9%) without SMAS. The three most common presenting symptoms were abdominal pain, postprandial discomfort, and early satiety. The clinical impressions based on history and physical examination before endoscopy were functional dyspepsia (34.6%), gastritis or gastric ulcer (31.0%), and SMAS (17.3%). The constellation of three endoscopic findings (finding I + II + III, feature D) observed in 13 (72.2%) patients of SMAS group and 3 (27.3%) patients of non SMAS group (P = 0.027). Of 16 patients with features D, SMAS was diagnosed in 13 patients (81.2%) and not detected in 3 patients (18.8%) on UGI series or hypotonic duodenography. Conclusions Endoscopic examination to the third part of the duodenum can provide a clue making a decision to evaluate SMAS, which consists of features of three endoscopic findings as follows: a pulsating vertical or oblique band or slit like luminal narrowing of the third part of the duodenum without no expansion over one third during air insufflation for at least 15 s, a marked dilation of the first and second part of the duodenum, and a bile lake in the stomach.
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Affiliation(s)
- Jae Young Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, 11 Samjunga-Ro, Sungsan-Gu, Changwon, 51472, South Korea. .,Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, South Korea.
| | - Myung Seok Shin
- Department of Pediatrics, College of Medicine, The Catholic University, St. Mary's Hospital, Daejeon, South Korea
| | - Sunho Lee
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, 11 Samjunga-Ro, Sungsan-Gu, Changwon, 51472, South Korea
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Kurisu K, Yamanaka Y, Yamazaki T, Yoneda R, Otani M, Takimoto Y, Yoshiuchi K. A clinical course of a patient with anorexia nervosa receiving surgery for superior mesenteric artery syndrome. J Eat Disord 2021; 9:79. [PMID: 34193279 PMCID: PMC8246657 DOI: 10.1186/s40337-021-00436-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/21/2021] [Indexed: 12/02/2022] Open
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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Affiliation(s)
- Ken Kurisu
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yukari Yamanaka
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tadahiro Yamazaki
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryo Yoneda
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Makoto Otani
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshiyuki Takimoto
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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Farina R, Gozzo C, Foti PV, Conti A, Vasile T, Pennisi I, Venturini M, Basile A. A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome. Radiol Case Rep 2021; 16:1264-1270. [PMID: 33854661 PMCID: PMC8026914 DOI: 10.1016/j.radcr.2021.02.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 01/27/2023] Open
Abstract
Median arcuate ligament syndrome and superior mesenteric artery syndrome are well-known abdominal compression syndromes, the coexistence of which is rarely described in literature. In addition, due to the common pathogenesis, anterior nutcracker syndrome may occur simultaneously to superior mesenteric artery syndrome. To our knowledge, this is the first case reporting combination of these 3 syndromes detected with ultrasound, Computed Tomography and upper gastrointestinal fluoroscopic exam. A 69-year-old man came to our attention for rapid weight loss, postprandial epigastric pain and recurrent vomiting for at least 6 months. Doppler ultrasound showed both celiac artery and left renal vein stenosis with simultaneous left varicocele. Computed tomography showed a reduction of aortomesenteric space causing both left renal vein and duodenal stenosis, this latter confirmed by upper gastrointestinal fluoroscopic exam. The diagnosis of these three vascular compression syndromes (MALS, SMAS, and anterior NCS) has been formulated, based on clinical and imaging findings. We assumed that the postprandial crises caused by median arcuate ligament syndrome may induce a reduction of meals consumption and progressive weight loss which can be a cause of anterior nutcracker syndrome and superior mesenteric artery syndrome onset. Doppler ultrasound, in expert hands, allows to accurately diagnosing these syndromes which are often underestimated. Failure to recognize it and inadequate treatment could have serious consequences for patients' health.
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Affiliation(s)
- Renato Farina
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiodiagnostic and Radiotherapy Unit, Catania, Italy
| | - Cecilia Gozzo
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiodiagnostic and Radiotherapy Unit, Catania, Italy
| | - Pietro Valerio Foti
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiodiagnostic and Radiotherapy Unit, Catania, Italy
| | - Andrea Conti
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiodiagnostic and Radiotherapy Unit, Catania, Italy
| | - Tiziana Vasile
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiodiagnostic and Radiotherapy Unit, Catania, Italy
| | - Isabella Pennisi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiodiagnostic and Radiotherapy Unit, Catania, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, Insumbria University, Varese, Italy
| | - Antonio Basile
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiodiagnostic and Radiotherapy Unit, Catania, Italy
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Esmat HA, Najah DM. Superior mesenteric artery syndrome caused by acute weight loss in a 16-year-old polytrauma patient: A rare case report and review of the literature. Ann Med Surg (Lond) 2021; 65:102284. [PMID: 33912344 PMCID: PMC8066379 DOI: 10.1016/j.amsu.2021.102284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Superior mesenteric artery syndrome is a rare entity, caused by compression of the duodenum between the superior mesenteric artery and the aorta. Case presentation A 16-year-old male in the inpatient service of our hospital complained of vomiting for two weeks. The patient had a long hospital stay in our center for the management of trauma-related complications, which resulted in significant weight loss despite the parenteral nutrition as he was unable for taking the enteral nutrition due to severe facial traumatic injury. In oral contrast study, the proximal duodenal segments were dilated. The contrast media could not reach the duodenojejunal junction in the supine position, though a small amount of the contras passed the distal duodenal part on repositioning the patient to prone. On abdominal CT images, the angle and distance between the superior mesenteric artery and the abdominal aorta were decreased to 20. 80, and 7.3 mm respectively. The findings were consistent with the superior mesenteric artery compression syndrome. He underwent a mini-laparotomy for the placement of a jejunostomy feeding tube aiming to promote weight gain and mesenteric fat restoration for preventing the SMA compression effects on the duodenum. Discussion The decrease in retroperitoneal fat owing to weight loss may result in aortomesenteric angle reduction and duodenal compression. Prompt nutritional support and timely diagnosis may preclude the need for more invasive surgical intervention. Conclusion Superior mesenteric artery syndrome is a rare condition, often resulting in small bowel obstruction. The clinical symptoms of this syndrome are nonspecific, which may underestimate the diagnosis. However, clinical suspicion supported by imaging study may help the accurate diagnosis. Superior mesenteric artery syndrome should be considered in all polytrauma and longstanding immobile patients present with rapid weight loss and vomiting. Superior mesenteric artery syndrome is a rare condition, often resulting in small bowel obstruction. The clinical symptoms of this syndrome are nonspecific, which may underestimate the diagnosis. Clinical suspicion supported by imaging study may help the accurate diagnosis. Prompt nutritional support and timely diagnosis may preclude the need for surgical intervention.
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Affiliation(s)
- Habib Ahmad Esmat
- Corresponding author. Fellow of radiology at EGE University Hospital, Izmir, Turkey.
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Zarour CC, Zaki-Metias KM, Mian A, Vempala M, Ogunde B, Tsibulski A, Bhatti ZS. Superior mesenteric artery syndrome secondary to an abdominal aortic aneurysm. Clin Imaging 2021; 78:35-37. [PMID: 33725497 DOI: 10.1016/j.clinimag.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/17/2021] [Accepted: 03/05/2021] [Indexed: 10/22/2022]
Abstract
Superior mesenteric artery (SMA) syndrome in association with abdominal aortic aneurysm (AAA) is exceedingly rare and has been noted to occur in patients with severe abdominal pain, bilious emesis, and a history of tobacco use. When symptoms of small bowel obstruction occur, it is imperative to investigate further with cross-sectional imaging to determine the etiology. Conservative management is preferred, but in cases of SMA syndrome with concomitant AAA, aneurysm repair should be considered, regardless of size, if initial treatment fails.
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Affiliation(s)
- Christopher C Zarour
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, United States
| | - Kaitlin M Zaki-Metias
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, United States.
| | - Arooj Mian
- Windsor University School of Medicine, Cayon, Saint Kitts and Nevis
| | | | - Barakat Ogunde
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, United States
| | - Alexander Tsibulski
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, United States
| | - Zeeshaan S Bhatti
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, United States; Huron Valley Radiology, Ypsilanti, MI, United States
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Requena-López AA, Mata-Samperio BK, Cuadra-Reyes LA, Casillas-Vargas R. Wilkie's syndrome as a cause of bowel obstruction in adults: A case report. CIR CIR 2020; 88:185-188. [PMID: 32116320 DOI: 10.24875/ciru.19001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is one of the rarest causes of small bowel obstruction. Clinical case A 36-year-old female patient, with a medical history of diabetes mellitus type 2, arrived at the emergency department with upper intestinal obstruction; a study protocol is made, integrating the diagnosis of Wilkie's syndrome. We performed a laparoscopic duodenojejunostomy, the patient did well in the post-operative period. Conclusions Laparoscopic duodenojejunostomy is a practical option to treat Wilkie's syndrome. It provides definitive treatment with the advantages and benefits of minimally invasive surgery.
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Affiliation(s)
- Abner A Requena-López
- Departamento de Cirugía General, Centro Médico, Instituto de Seguridad Social del Estado de México (ISSEMyM), Ecatepec, Estado de México, México
| | - Brenda K Mata-Samperio
- Departamento de Cirugía General, Centro Médico, Instituto de Seguridad Social del Estado de México (ISSEMyM), Ecatepec, Estado de México, México
| | - Luis A Cuadra-Reyes
- Departamento de Cirugía General, Centro Médico, Instituto de Seguridad Social del Estado de México (ISSEMyM), Ecatepec, Estado de México, México
| | - Ricardo Casillas-Vargas
- Departamento de Cirugía General, Centro Médico, Instituto de Seguridad Social del Estado de México (ISSEMyM), Ecatepec, Estado de México, México
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Sakurai Y, Hirai F, Abe M, Okaya T, Suzuki H, Sugano I. A case of gastric ischemia caused by massive gastric dilatation due to superior mesenteric artery syndrome. Clin J Gastroenterol 2020; 13:1066-9. [PMID: 32720221 DOI: 10.1007/s12328-020-01192-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023]
Abstract
Gastric ischemia is extremely rare and its endoscopic findings appear similar to those of malignant tumors, which makes accurate diagnosis difficult. We present the case of a 41-year-old woman who was admitted to our hospital for severe abdominal pain and vomiting. Laboratory data at the time of admission indicated high serum levels of C-reactive protein, fibrin/fibrinogen degradation products and D-dimer. An abdominal computed tomography (CT) scan revealed a massive dilatation of the stomach and descending portion of the duodenum, which abruptly narrowed at the portion between the superior mesenteric artery and the aorta, indicating massive gastric and duodenal dilatation due to superior mesenteric artery syndrome. Decompression of the upper gastrointestinal tract using a nasogastric tube was started immediately. An esophagogastroduodenoscopy revealed a massive, irregular ulcerative lesion with ill-defined boundaries located in the posterior wall along the greater curvature of the stomach. Although this lesion mimicked a malignant lesion, the biopsy findings revealed a benign gastric ulcer, indicating that the lesion was gastric ischemia caused by the increased intragastric pressure resulting from the massive dilatation. The gastric ischemia healing process was successfully observed through repeated endoscopic examinations of the upper gastrointestinal tract. The patient's abdominal symptoms disappeared within 10 days and she was discharged from the hospital 23 days after the abdominal episode. This case highlights gastric ischemia associated with an acute massive gastric dilatation resulting in increased intragastric pressure caused by superior mesenteric artery syndrome.
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Karki B, Pun B, Shrestha A, Shrestha PS. Superior mesenteric artery syndrome. Clin Case Rep 2020; 8:2295-2297. [PMID: 33235782 PMCID: PMC7669412 DOI: 10.1002/ccr3.3118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/30/2022] Open
Abstract
Superior mesenteric artery (SMA) syndrome, though rare, should be considered in patients with duodenal obstruction with no other causes. History of recent weight loss and imaging modalities help in the diagnosis. Conservative management can be tried before going for surgery.
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Affiliation(s)
- Bipin Karki
- Department of Critical Care Medicine Om Hospital and Research Center Kathmandu Nepal
| | - Bishika Pun
- Department of Radiology Om Hospital and Research Center Kathmandu Nepal
| | - Amit Shrestha
- Department of Radiology Nepal Medical College and Teaching Hospital Kathmandu Nepal
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Dekonenko C, Hill JA, Sobrino JA, Snyder CL, St Peter SD, Oyetunji TA. Ligament of Treitz Release With Duodenal Lowering for Pediatric Superior Mesenteric Artery Syndrome. J Surg Res 2020; 254:91-95. [PMID: 32422431 DOI: 10.1016/j.jss.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/26/2020] [Accepted: 04/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Operative approaches for superior mesenteric artery syndrome (SMAS) vary from Roux-en-Y duodenojejunostomy to the more conservative division of the ligament of Treitz with inferior duodenal derotation known as the Strong procedure. We sought to examine outcomes following a modified version of Strong procedure where the duodenum is lowered as opposed to derotated for the management of SMAS. MATERIALS AND METHODS We conducted a retrospective chart review of children who underwent surgical management of SMAS between January 2008 and December 2017. An online survey regarding symptom resolution, feeding practices, and the need for additional procedures was distributed. Data are reported as medians with interquartile range (IQR) and proportions as percentages. RESULTS Seven patients with a median age of 15 y (IQR 8, 16) and median body mass index of 16.9 (IQR, 12.6, 22.1) were included. Presenting symptoms included pain (71%), nausea (57%), and vomiting (43%). Six patients initially underwent duodenal lowering, whereas one patient underwent duodenoduodenostomy. One patient underwent adhesiolysis for bowel obstruction in the early postoperative period. All patients had symptom resolution at a postoperative follow-up of 22 d (IQR, 15, 45). Two patients had symptom recurrence, and one patient required reoperation. Six patients completed the survey at a median of 2.3 y (IQR, 1.7, 3.2) postoperatively, of which four underwent duodenal lowering. Of these, 75% (n = 3) were asymptomatic. One patient with recurrence reported occasional nausea and emesis but has not required additional surgery. CONCLUSIONS Release of the ligament of Treitz with duodenal lowering results in resolution of symptoms in 75% of patients. This operative approach may be considered before performing more complex operations for SMAS.
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Affiliation(s)
- Charlene Dekonenko
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Joshua A Hill
- School of Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - Justin A Sobrino
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Charles L Snyder
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri; Department of Surgery, Quality Improvement and Surgical Equity Research (QISER) Center, Children's Mercy Kansas City, Kansas City, Missouri.
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Jain N, Chopde A, Soni B, Sharma B, Saini S, Mishra S, Mishra S, Gupta R, Bhojwani R. SMA syndrome: management perspective with laparoscopic duodenojejunostomy and long-term results. Surg Endosc 2021; 35:2029-38. [PMID: 32342220 DOI: 10.1007/s00464-020-07598-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/22/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Superior mesentery artery syndrome (SMAS) is a rare vasculo-anatomic occlusive pathologic entity for which a period of conservative medical management is advocated with surgery reserved for nonresponsive cases. We present our management plan that entails a single admission approach and complete rendering of medical and surgical treatment to the patient on a background of the socioeconomic and cultural trends prevalent in this geographic region. METHODS A retrospective analysis of 22 cases of SMAS admitted in our health care system who underwent a period of preoperative conditioning followed by laparoscopic duodenojejunostomy from September 2009 to June 2019 was performed. Patients were followed up at regular intervals. RESULTS The mean follow-up of the cohort was 41.2 months (2-108 months). The median length of stay was 6 days. The mean postoperative stay was 4.13 days. A subgroup of six patients who had severe physiological depletion required a period of preoperative optimisation. Five of the 22 (22.7%) patients suffered from postoperative complications in the form of delayed return of bowel functions. None of the patients had complications more than Clavien-Dindo grade 2 with no mortality. Long-term data are available for 19 patients (86.3%) which showed no symptom recurrence. CONCLUSION Management of SMAS that entails an antecedent medical therapy followed by surgery can be accomplished in a single admission with good to excellent results in the intermediate and long-term follow-up. Physiologically depleted patients do require a period of intensive preconditioning but on long-term follow-up, they have excellent results.
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Abstract
INTRODUCTION Compression of the duodenum and left renal vein between the aorta and superior mesenteric artery usually leads to symptoms of proximal bowel obstruction or hematuria and, more rarely, nonspecific mild headaches. CASE A young woman presented with new daily persistent headache refractory to numerous pharmacological treatments, onabotulinumtoxinA, nerve blocks, and occipital nerve stimulation. Following several years of daily severe headache, worsening abdominal pain and intolerance for food intake led to the discovery of aortomesenteric compression. Surgical treatment gave prompt improvement in gastric symptoms but also essentially resolved the headache. CONCLUSION This is the first description of new daily persistent headache in association with aortomesenteric compression as well as marked improvement of headache following aortomesenteric decompression. In patients with new daily persistent headache and orthostatic symptoms one may consider a differential diagnosis of Nutcracker syndrome, especially in patients with comorbid hypermobility syndromes, hematuria or gastric symptoms.
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Affiliation(s)
- Anker Stubberud
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Sanjay Cheema
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Erling Tronvik
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Abstract
The underlying etiologies of paediatric bowel obstruction are wide ranging. It can be divided into proximal and distal bowel obstruction. Amongst the different etiologies of the proximal bowel obstructions at the level of the duodenum, there are a few etiologies including duodenal atresia, internal hernias, intestinal malrotation, annular pancreas etc. Superior mesenteric artery syndrome is amongst one of these differential diagnoses which is more prevalent in the adolescent age group. We describe the imaging features of this entity and its demographics, imaging characteristics, treatment and prognosis.
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Affiliation(s)
- Perry Liew Jia Ren
- Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, Singapore
| | - Achint Gupta
- Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, Singapore
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Wan S, Zhang L, Yang J, Gao X, Wang X. Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy: A Retrospective Case-Series Study in a Single Institution. Ann Nutr Metab 2020; 76:37-43. [PMID: 32172254 DOI: 10.1159/000506620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/16/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Superior mesenteric artery syndrome (SMAS) is a relatively rare cause of chronic duodenal obstruction, owing to the compression of the third portion of the duodenum. OBJECTIVES This retrospective study aims to discuss the efficacy of enteral nutrition (EN) therapy in nutritional status and symptom improvement at a short-term follow-up for SMAS patients. METHODS We retrospectively analyzed clinical data of patients diagnosed as SMAS and treated with EN from September 2012 to January 2019. RESULTS Twenty-six patients were included (16 women; mean age 24.96 ± 11.77 years), none was excluded, and one was lost to follow-up. The patients' mean body weight was 40.94 ± 10.16 kg, mean weight loss 11.73 ± 7.58 kg, and mean body mass index (BMI) 14.82 ± 2.52 kg/m2. The mean duration of EN therapy was 10.10 ± 4.66 months. Serum level of nutritional indicators, BMI and body weight increased after EN therapy. During a median follow-up of 24 months (9-44) after EN therapy, the mean symptom score decreased from 24.28 ± 9.57 to 8.06 ± 8.29 (p < 0.0001), and 65% of patients' symptoms resolved and 15% of patients' symptoms improved. In total, 16 complications occurred, including tube blockage, peristomal wound infections, peristomal leakage, granulomas, and nasopharyngeal pain. CONCLUSION EN therapy may be an effective option for SMAS patients. While it might not remove all symptoms, it can improve the nutritional status to support subsequent treatments.
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Affiliation(s)
- Songlin Wan
- Department of General Surgery, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Li Zhang
- Department of General Surgery, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jianbo Yang
- Department of General Surgery, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xuejin Gao
- Department of General Surgery, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinying Wang
- Department of General Surgery, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China,
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Bing L, Shun-Lin X, Ji-Hua O, Wei-Bing C, Ye-Bo W. Laparascopic Ladd's procedure as treatment alternative, when parenteral or prolonged hospital nutrition is not an option for superior mesenteric artery syndrome. J Pediatr Surg 2020; 55:554-557. [PMID: 30376960 DOI: 10.1016/j.jpedsurg.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/16/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Superior mesenteric artery syndrome (SMAS) is an uncommon cause of duodenal obstruction in pediatric patients. It is extremely rare in young infants. The classic treatment for SMAS has been an open or laparoscopic duodenojejunostomy when conservative medical therapy failed to resolve the obstruction. We herein reported 3 cases of SMAS in infants treated by laparoscopic Ladd's procedure. The advantages and feasibility of laparoscopic Ladd's procedure applied for SMAS in infants were discussed. METHODS Three cases of infants with SMAS subjected to laparoscopic Ladd's procedure in our hospital were collected from January 2014 to December 2015. The patients' age, operative time, postoperative hospital observation, resumption of full diet, and postoperative complications were analyzed. RESULTS The median age at operation was 8 months (range, 6-9 months). The mean body weight was 7.9 kg (range, 6.5-8.8 kg). The mean operative time was 66.7 min (range, 65-75 min). The mean postoperative hospital stay was 4.3 days (range, 4-5 days) and the follow-up was 20.7 months (range, 12-34 months) without any specific postoperative complications. CONCLUSION Based on our reports, laparoscopic Ladd's procedure is a reliable and practicable minimally invasive surgery for in infants with SMAS.
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Affiliation(s)
- Li Bing
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, 104 Renmin Road South, Jiang Su, 223002, PR China.
| | - Xia Shun-Lin
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, 104 Renmin Road South, Jiang Su, 223002, PR China
| | - Ou Ji-Hua
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, 104 Renmin Road South, Jiang Su, 223002, PR China
| | - Chen Wei-Bing
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, 104 Renmin Road South, Jiang Su, 223002, PR China
| | - Wang Ye-Bo
- Department of General Surgery, Huai'an First People's Hospital, Nanjing Medical University, 6 Beijing Road West, Huai'an, Jiangsu 223300, PR China
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Hirai T, Kitada M, Hayashi Y, Monno I, Takagaki Y, Shimada K, Ogura Y, Fujii M, Konishi K, Nakagawa A, Koya D. Case report of superior mesenteric artery syndrome that developed in a lean type 2 diabetes patient and was associated with rapid body weight loss after sodium-glucose cotransporter 2 inhibitor administration. J Diabetes Investig 2020; 11:1359-1362. [PMID: 32020751 PMCID: PMC7477529 DOI: 10.1111/jdi.13228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/21/2020] [Accepted: 02/02/2020] [Indexed: 11/28/2022] Open
Abstract
A 58-year-old women who was diagnosed with type 2 diabetes 20 years earlier had been treated with antidiabetic medicines since she was aged 40 years. After sodium-glucose cotransporter 2 inhibitors administration, her bodyweight rapidly decreased from 40 to 30 kg over a period of 3 weeks. She had abdominal symptoms, including nausea, especially after a meal. On admission, physical examinations and laboratory data showed euglycemic ketoacidosis, dehydration and low insulin secretion levels. Additionally, abdominal contrast computed tomography showed the finding of superior mesenteric artery syndrome. This case urges caution, including rapid excessive bodyweight loss and euglycemic ketoacidosis, on the use of sodium-glucose cotransporter 2 for lean diabetes patients.
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Affiliation(s)
- Taro Hirai
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan
| | - Munehiro Kitada
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan
| | - Yoshihiro Hayashi
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan
| | - Itaru Monno
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan
| | - Yuta Takagaki
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan
| | - Keiji Shimada
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan
| | - Yoshio Ogura
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan
| | - Mizue Fujii
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan
| | - Kazunori Konishi
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan
| | - Atsushi Nakagawa
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan
| | - Daisuke Koya
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan
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Xu MM, Dawod E, Gaidhane M, Tyberg A, Kahaleh M. Reverse Endoscopic Ultrasound-Guided Gastrojejunostomy for the Treatment of Superior Mesenteric Artery Syndrome: A New Concept. Clin Endosc 2019; 53:94-96. [PMID: 31794656 PMCID: PMC7003011 DOI: 10.5946/ce.2018.196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/08/2019] [Indexed: 12/11/2022] Open
Abstract
Superior mesenteric artery syndrome (SMAS) causes compression and partial or complete obstruction of the duodenum, resulting in abdominal pain, nausea, vomiting, and weight loss. If conservative therapy fails, the patient is typically referred for enteral feeding or laparoscopic gastrojejunostomy. The last few years have seen increasing use of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) for gastric obstruction indications. EUS-GJ involves the creation of a gastric bypass via an echoendoscope in cases in which the small intestine can be punctured under ultrasonographic visualization, resulting in an incision-free, efficient, and safe procedure. In this case report, we present the first case of SMAS treated using a reverse EUS-GJ, and describe the steps and advantages of the procedure in this particular case.
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Affiliation(s)
- Ming-Ming Xu
- Division of Gastroenterology, Kaiser Permanente, Los Angeles, CA, USA
| | - Enad Dawod
- Division of Gastroenterology, Weill Cornell Medical College, New York, NY, USA
| | - Monica Gaidhane
- Division of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Amy Tyberg
- Division of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
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Kawabata H, Sone D, Yamaguchi K, Inoue N, Okazaki Y, Ueda Y, Hitomi M, Miyata M, Motoi S. Endoscopic Gastrojejunostomy for Superior Mesenteric Artery Syndrome Using Magnetic Compression Anastomosis. Gastroenterology Res 2019; 12:320-323. [PMID: 31803313 PMCID: PMC6879032 DOI: 10.14740/gr1229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 12/18/2022] Open
Abstract
An 89-year-old woman who was bedridden suffered repeated vomiting due to superior mesenteric artery syndrome (SMAS). We performed gastrojejunostomy via the magnetic compression anastomosis (MCA) technique because her situation was not improved by conservative therapy and because the operative risk was high. We prepared two neodymium magnets: a flat plate-shaped magnet (15 × 3 mm) and a ring-shaped magnet of the same size. The ring-shaped magnet which passed through a guidewire was pushed to the duodenum by an endoscope over the guidewire. The duodenal stricture was balloon-dilated in front of the magnet, and the magnet was pushed all together beyond the stricture and placed at the duodenojejunal junction. Subsequently, the flat plate-shaped magnet was delivered endoscopically to the stomach using a biopsy forceps. The magnets were attracted towards each other transmurally after one more flat plate-shaped magnet was added to the gastric-side magnet. Completion of gastrojejunostomy was confirmed while retrieving the magnets 10 days after starting compression. She has been asymptomatic for 1 month since anastomosis. Endoscopic gastrojejunostomy using MCA was an effective, low-invasive treatment for SMAS.
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Affiliation(s)
- Hideaki Kawabata
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034, Japan
| | - Daiki Sone
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034, Japan
| | - Katsutoshi Yamaguchi
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034, Japan
| | - Naonori Inoue
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034, Japan
| | - Yuji Okazaki
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034, Japan
| | - Yuki Ueda
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034, Japan
| | - Misuzu Hitomi
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034, Japan
| | - Masatoshi Miyata
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034, Japan
| | - Shigehiro Motoi
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034, Japan
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Frongia G, Schenk JP, Schaible A, Sauer P, Mehrabi A, Günther P. Food fear, quick satiety and vomiting in a 16 years old girl: It's bulimia, or maybe not…? A case report of Wilkie's syndrome ( superior mesenteric artery syndrome). Int J Surg Case Rep 2019; 65:184-8. [PMID: 31726254 DOI: 10.1016/j.ijscr.2019.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 11/22/2022] Open
Abstract
Wilkie’s syndrome (WS) is a rare but impairing condition. WS is defined by an aorto-mesenteric artery angle <25° or an aorto-mesenteric distance of <8 mm. Conservative approaches aim at restoring the correct aorto-mesenteric artery angle. Surgical approaches aim at bypassing the functional duodenal obstruction. The overall WS outcome is good in 80–90% of cases.
Introduction Wilkie’s syndrome (WS), also known as superior mesenteric artery syndrome, is a rare clinical entity caused by compression of the horizontal (third) part of the duodenum between the superior mesenteric artery and the abdominal aorta leading to duodenal obstruction. Presentation of case We report a case of a 16 years girl with long-term history of spontaneous vomiting and self-induced vomiting, also suffering from recurrent retrosternal pain, weight loss and thus reduced quality of life. Contrast intestinal series showed a large axial hernia which was laparoscopically reduced and treated by hiatoplasty and anterior hemifundoplication. After initial relief, recurrent postprandial nausea and vomiting reoccurred 4 weeks postoperatively. Abdominal MRI study revealed findings compatible with WS. After endoscopic exclusion of an anatomical duodenal lumen stenosis, she was successfully treated by duodeno-jejunostomy with a favorable outcome. Discussion WS might be hidden behind presumably more evident diagnoses such as bulimia, significant axial hernia and gastro-esophageal reflux disease in patients with recurred vomiting, abdominal pain and weight loss. Conclusion The rare clinical entity of a WS necessitates a targeted diagnostic evaluation and therapy. Clinical details, diagnostic studies and treatment are discussed here.
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Abstract
Introduction Wilkie's syndrome is a rare entity that presents as a chronic intestinal obstruction secondary to mechanical compression of the third portion of the duodenum due to a decreased aorto-mesenteric angle. This entity has a reported incidence of 0.012 to 2.4% and can lead to high morbidity and mortality; In addition, there are major controversies regarding its diagnosis and treatment, which is why the authors present a case report of a patient with a diagnosis of Wilkie's syndrome and its surgical management via laparoscopy. Methods A case of a patient with clinical and imaging manifestations of superior mesenteric artery syndrome is presented, along with acritical review of the literature, taking into account articles published in the PubMed and ScienceDirect databases during the past 8 years. Clinical case A 27-year-old patient with 20 years of abdominal pain that exacerbated one week before admission, with a clinical and imaging manifestations of Wilkie's syndrome. Patient presents refractoriness to medical management, which led to a surgical approach with laparoscopic duodenum-jejunostomy that was carried out without perioperative complications and satisfactory results. Discussion and conclusions The superior mesenteric artery syndrome is a rare entity that in some scenarios requires surgical management. The laparoscopic duodeno-jejunostomy is the procedure of choice to manage this entity as evidenced in our case, which is also consistent with what is reported in the world medical literature.
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Affiliation(s)
- Henry Martínez
- Servicio de Cirugía General, Hospital Universitario de la Samaritana, Bogotá, Colombia
| | | | | | - Mauricio Pedraza
- Servicio de Cirugía General, Universidad El Bosque, Bogotá, Colombia
| | - Luis F Cabrera
- Servicio de Cirugía General, Universidad El Bosque, Bogotá, Colombia
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Abstract
PURPOSE To provide a review of the etiology, clinical presentation, and imaging findings of superior mesenteric artery (SMA) syndrome. METHODS A literature review of 24 relevant articles regarding SMA syndrome was performed. RESULTS Clinicians and radiologists with a high index of suspicion based on symptomatology may pursue radiologic investigation in the form of upper gastrointestinal (GI) series and contrast-enhanced abdominal computed tomography (CT). Magnetic resonance imaging (MRI) and ultrasound (US) are less commonly utilized modalities in the work-up of SMA syndrome, but provide imaging alternatives without the use of ionizing radiation. Imaging can assist in diagnosis by demonstrating characteristic findings of reduced aortomesenteric angle, reduced aortomesenteric distance, gastroduodenal distention, bowel caliber narrowing at the takeoff of the superior mesenteric artery from the aorta, as well as delayed gastric emptying or positional obstruction observed with real time with fluoroscopy. CONCLUSION SMA syndrome is a rare disease that can go unrecognized and undiagnosed, exacerbating weight loss in an already significantly malnourished patient population. The diagnosis of SMA syndrome must be based on clinical symptomatology correlated with radiographic information. Once diagnosed, SMA syndrome can be safely treated by conservative measures although occasionally requires invasive intervention in the form of enteral tube placement, percutaneous jejunostomy tube placement, total parenteral nutrition, ligament of Treitz lysis, or duodenojejunostomy.
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Furuya Y, Wakahara T, Furuya A, Yanagie H, Yasuhara H. Rare bowel emphysema with superior mesenteric artery syndrome after surgery. Ann R Coll Surg Engl 2019; 102:e26-e28. [PMID: 31418283 DOI: 10.1308/rcsann.2019.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Superior mesenteric artery syndrome, a rare cause of duodenal obstruction, occasionally requires surgery. Bowel emphysema might also require surgery and might be an ominous sign of a serious condition. We report the case of a 69-year-old Japanese man with left pneumothorax who was also diagnosed as having bowel emphysema and superior mesenteric artery syndrome simultaneously without serious infection after surgery for the pneumothorax. Following gastric decompression via a nasogastric tube, his general condition resolved quickly with no need for surgical intervention. Prompt and precise diagnosis by computed tomography and both adequate judgment and treatment can avoid surgery in such cases.
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Affiliation(s)
- Y Furuya
- Department of Surgery, Sodegaura Satsukidai Hospital, Sodegaura, Chiba, Japan
| | - T Wakahara
- Department of Surgery, Sodegaura Satsukidai Hospital, Sodegaura, Chiba, Japan
| | - A Furuya
- Department of Medical Research, Sodegaura Satsukidai Hospital, Sodegaura, Chiba, Japan
| | - H Yanagie
- Research Institute of Healthy Living, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Akiba, Niigata, Japan
| | - H Yasuhara
- Surgical Center, University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Lee CI, Wu YH. Pneumatosis intestinalis and pneumoretroperitoneum post steroid use in a patient with superior mesenteric artery syndrome. Am J Emerg Med 2019; 37:1993.e1-1993.e3. [PMID: 31262624 DOI: 10.1016/j.ajem.2019.06.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/23/2019] [Indexed: 11/19/2022] Open
Abstract
Pneumatosis intestinalis (PI) refers to the presence of gas within the wall of the small or large intestine. PI can be both asymptomatic and life-threatening. The patient was a 50-year-old man with previous cervical spine abscess and osteomyelitis post debridement 4 years ago, with a heroin abuse history. He presented with abdominal distension ongoing for 4 days and vomiting for 3 times with fluid content. Abdominal computed tomography revealed pneumatosis with pneumoretroperitoneum. A surgeon was contacted and antibiotic treatment was started. The patient was kept on nothing per os and intravenous fluid supply. A drainage tube was inserted into retroperitoneum space on the same day. Tracing back his history, our patient was discharged from the hospital recently with a diagnosis of superior mesenteric artery dyndrome (SMAS), hypersensitivity pneumonitis, and asbestosis with soft tissue pleural plaques and calcified pleural plaques. During the hospitalization period, hydrocortisone dexamethasone and methylprednisolone were prescribed for hypersensitivity pneumonitis. Steroid use and SMAS maybe the cause of PI. Finally, he was discharged 5 days later with a nasojejunal and drainage tubes and was arranged for OPD follow-up. PI can be asymptomatic or life-threatening, and patient management varies based on the clinical condition. Although in this case PI was found in the emergency department, a patient's past history of underlying disease and medication should be reviewed to find the most possible etiology.
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Affiliation(s)
- Ching-I Lee
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hung Wu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Wang T, Wang ZX, Wang HJ. Clinical Insights into Superior Mesenteric Artery Syndrome with Multiple Diseases: A Case Report. Dig Dis Sci 2019; 64:1711-1714. [PMID: 30569335 DOI: 10.1007/s10620-018-5436-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 12/14/2018] [Indexed: 12/09/2022]
Affiliation(s)
- Tao Wang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, 810000, Xining, Qinghai, China
| | - Zhi-Xin Wang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, 810000, Xining, Qinghai, China
| | - Hai-Jiu Wang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, 810000, Xining, Qinghai, China.
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Ganss A, Rampado S, Savarino E, Bardini R. Superior Mesenteric Artery Syndrome: a Prospective Study in a Single Institution. J Gastrointest Surg 2019; 23:997-1005. [PMID: 30291587 DOI: 10.1007/s11605-018-3984-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 09/17/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction, resulting from the compression of the duodenum between superior mesenteric artery and aorta. This prospective registry aims to describe demographic, clinical, and outcome features of patients suffering from SMAS and to point out the indications for surgery. METHODS Between 2008 and 2016, patients with chronic gastrointestinal symptoms and diagnosis of SMAS were included. Demographics, clinical presentation, diagnosis, and surgical outcome were recorded. Symptoms were investigated with a standardized questionnaire. The diagnosis was achieved through barium swallow, CT/MR angiography (aortomesenteric angle ≤ 22°, distance ≤ 8 mm), endoscopy. All patients underwent duodenojejunostomy ± distal duodenum resection. At follow-up, symptom score and barium swallow were re-evaluated. RESULTS Thirty-nine patients (11 M/28 F, median age 38 years, median BMI 17.8 kg/m2) were included. Barium swallow showed a gastroduodenal dilation in 57% of patients, and a delayed gastroduodenal emptying in 38%. Median aortomesenteric angle was 11° and distance was 5 mm. All patients underwent duodenojejunostomy, and in 32 patients, a distal duodenum resection was also performed. At a median follow-up of 47 months, the overall symptom score significantly dropped (10 vs. 32, p < 0.0001) and BMI increased (19.5 vs. 17.8, p < 0.0001). Barium swallow at 2 months postoperatively showed an improvement in terms of gastroduodenal dilation and emptying in 38% of patients with preoperative pathological findings. CONCLUSIONS SMAS is a rare condition that should be suspected in cases of chronic, refractory upper digestive symptoms, particularly in females with low BMIs. Surgical treatment may improve symptoms and quality of life, although it is not curative in all cases. ClinicalTrials.gov Identifier: NCT03416647.
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