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Abdominal Radiology

, Volume 44, Issue 9, pp 3188–3194 | Cite as

Superior mesenteric artery syndrome: a radiographic review

  • Emily S. WarnckeEmail author
  • Dorissa L. Gursahaney
  • Margherita Mascolo
  • Elizabeth Dee
Review

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.

Keywords

Superior mesenteric artery syndrome Duodenal obstruction Radiography Tomography X-ray computed Fluoroscopy 

Notes

Acknowledgements

The authors thank Anjuli Cherukuri, MD for the medical illustrations.

Compliance with ethical standards

Funding

There are no relevant sources of funding or financial interest to disclose.

Conflicts of interest

There are no potential conflicts of interest. The retrospectively collected images were obtained in the course of treatment and have been anonymized with no personal identifying information.

Ethical approval

The article was approved by the Colorado Multiple Institutional Review Board. This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Von Rokitansky C (1861) Lehrburch der pathologischen anatomie. Wien: Braumulle, p 187Google Scholar
  2. 2.
    Wilkie DP (1927) Chronic duodenal ileus. Am J Med Sci 173:643–649CrossRefGoogle Scholar
  3. 3.
    Agrawal GA, Johnson PT, Fishman EK (2007) Multidetector row CT of superior mesenteric artery syndrome. J Clin Gastroenterol 41:62–65.  https://doi.org/10.1097/MCG.0b013e31802dee64 CrossRefGoogle Scholar
  4. 4.
    Konen E, Amitai M, Apter S, et al. (1998) CT angiography of superior mesenteric artery syndrome. AJR Am J Roentgenol 171:1279–1281.  https://doi.org/10.2214/ajr.171.5.9798861 CrossRefGoogle Scholar
  5. 5.
    Goin LS, Wilk SP (1956) Intermittent aortomesenteric occlusion of the duodenum. Radiology 67:729–737CrossRefGoogle Scholar
  6. 6.
    Welsch T, Büchler MW, Kienle P (2007) Recalling superior mesenteric artery syndrome. Dig Surg 24:149–156.  https://doi.org/10.1159/000102097 CrossRefGoogle Scholar
  7. 7.
    Neri S, Signorelli SS, Mondati E, et al. (2005) Ultrasound imaging in diagnosis of superior mesenteric artery syndrome. J Internal Med 257:346–351.  https://doi.org/10.1111/j.1365-2796.2005.01456.x CrossRefGoogle Scholar
  8. 8.
    Keskin M, Akgul T, Bayraktar A, et al. (2014) Superior mesenteric artery syndrome: an infrequent complication of scoliosis surgery. Case Rep Surg 2014:263431.  https://doi.org/10.1155/2014/263431 Google Scholar
  9. 9.
    Cardarelli-Leite L, Velloni FG, Salvadori PS, et al. (2016) Abdominal vascular syndromes: characteristic imaging findings. Radiol Bras 49:257–263.  https://doi.org/10.1590/0100-3984.2015.0136 CrossRefGoogle Scholar
  10. 10.
    Lamba R, Tanner DT, Sekhon S, et al. (2014) Multidetector CT of vascular compression syndromes in the abdomen and pelvis. Radiographics 34:93–115.  https://doi.org/10.1148/rg.341125010 CrossRefGoogle Scholar
  11. 11.
    Shah D, Naware S, Thind S, Kuber R (2013) Superior mesenteric artery syndrome: an uncommon cause of abdominal pain mimicking gastric outlet obstruction. Ann Med Health Sci Res .  https://doi.org/10.4103/2141-9248.121214 Google Scholar
  12. 12.
    Merrett ND, Wilson RB, Cosman P, Biankin AV (2009) Superior mesenteric artery syndrome: diagnosis and treatment strategies. J Gastrointest Surg 13:287–292.  https://doi.org/10.1007/s11605-008-0695-4 CrossRefGoogle Scholar
  13. 13.
    Hughes JP, McEntire JE, Setze TK (1974) Cast syndrome: duodenal dilation or obstruction in a patient in a body cast, with review of the literature. Arch Surg 108:230–232CrossRefGoogle Scholar
  14. 14.
    Griffiths GJ, Whitehouse GH (1978) Radiological features of vascular compression of the duodenum occurring as a complication of the treatment of scoliosis (the cast syndrome). Clin Radiol 29:77–83CrossRefGoogle Scholar
  15. 15.
    Unal B, Aktaş A, Kemal G, et al. (2005) Superior mesenteric artery syndrome: CT and ultrasonography findings. Diagn Interv Radiol 11:90–95Google Scholar
  16. 16.
    Hines JR, Gore RM, Ballantyne GH (1984) Superior mesenteric artery syndrome. Diagnostic criteria and therapeutic approaches. Am J Surg 148:630–632CrossRefGoogle Scholar
  17. 17.
    Lippl F, Hannig C, Weiss W, et al. (2002) Superior mesenteric artery syndrome: diagnosis and treatment from the gastroenterologist’s view. J Gastroenterol 37:640–643.  https://doi.org/10.1007/s005350200101 CrossRefGoogle Scholar
  18. 18.
    Cicero G, D’Angelo T, Bottari A, et al. (2018) Superior mesenteric artery syndrome in patients with Crohn’s disease: a description of 2 cases studied with a novel magnetic resonance enterography (MRE) procedure. Am J Case Rep 19:431–437CrossRefGoogle Scholar
  19. 19.
    Chin LW, Chou MC, Wang HP (2007) Ultrasonography diagnosis of superior mesenteric artery syndrome in the ED. Am J Emerg Med 25:864CrossRefGoogle Scholar
  20. 20.
    Mauceri B, Misseri M, Tsami A, et al. (2010) Ultrasound in diagnosis of superior mesenteric artery syndrome. Clin Ter 161:35–37Google Scholar
  21. 21.
    Tsirikos AI, Jeans LA (2005) Superior mesenteric artery syndrome in children and adolescents with spine deformities undergoing corrective surgery. J Spinal Disord Tech 18:263–271Google Scholar
  22. 22.
    Wyten R, Kelty CJ, Falk GL (2010) Laparoscopic duodenojejunostomy for the treatment of superior mesenteric artery (SMA) syndrome: case series. J Laparoendosc Adv Surg Tech A 20:173–176.  https://doi.org/10.1089/lap.2009.0237 CrossRefGoogle Scholar
  23. 23.
    Strong EK (1958) Mechanics of arteriomesenteric duodenal obstruction and direct surgical attack upon etiology. Ann Surg 148:725–730CrossRefGoogle Scholar
  24. 24.
    Pottorf BJ, Husain FA, Hollis HW Jr, Lin E (2014) Laparoscopic management of duodenal obstruction resulting from superior mesenteric artery syndrome. JAMA Surg 149:1319–1322.  https://doi.org/10.1001/jamasurg.2014.1409 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiology, School of MedicineUniversity of ColoradoAuroraUSA
  2. 2.Alsana: An Eating Recovery CommunityThousand OaksUSA
  3. 3.Department of RadiologyDenver Health Medical CenterDenverUSA

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