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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References
Von Rokitansky C (1861) Lehrburch der pathologischen anatomie. Wien: Braumulle, p 187
Wilkie DP (1927) Chronic duodenal ileus. Am J Med Sci 173:643–649
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
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
Goin LS, Wilk SP (1956) Intermittent aortomesenteric occlusion of the duodenum. Radiology 67:729–737
Welsch T, Büchler MW, Kienle P (2007) Recalling superior mesenteric artery syndrome. Dig Surg 24:149–156. https://doi.org/10.1159/000102097
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
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
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
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
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
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
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 108:230–232
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 29:77–83
Unal B, Aktaş A, Kemal G, et al. (2005) Superior mesenteric artery syndrome: CT and ultrasonography findings. Diagn Interv Radiol 11:90–95
Hines JR, Gore RM, Ballantyne GH (1984) Superior mesenteric artery syndrome. Diagnostic criteria and therapeutic approaches. Am J Surg 148:630–632
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
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 19:431–437
Chin LW, Chou MC, Wang HP (2007) Ultrasonography diagnosis of superior mesenteric artery syndrome in the ED. Am J Emerg Med 25:864
Mauceri B, Misseri M, Tsami A, et al. (2010) Ultrasound in diagnosis of superior mesenteric artery syndrome. Clin Ter 161:35–37
Tsirikos AI, Jeans LA (2005) Superior mesenteric artery syndrome in children and adolescents with spine deformities undergoing corrective surgery. J Spinal Disord Tech 18:263–271
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
Strong EK (1958) Mechanics of arteriomesenteric duodenal obstruction and direct surgical attack upon etiology. Ann Surg 148:725–730
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
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The authors thank Anjuli Cherukuri, MD for the medical illustrations.
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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.
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Warncke, E.S., Gursahaney, D.L., Mascolo, M. et al. Superior mesenteric artery syndrome: a radiographic review. Abdom Radiol 44, 3188–3194 (2019). https://doi.org/10.1007/s00261-019-02066-4
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DOI: https://doi.org/10.1007/s00261-019-02066-4