Skip to main content

Superior Mesenteric Artery Syndrome: Diagnosis and Treatment Strategies

Abstract

Introduction

Superior mesenteric artery (SMA) syndrome is an unusual cause of vomiting and weight loss resulting from the compression of the third part of the duodenum by the SMA. Various medical and psychiatric conditions may result in the initial rapid weight loss which causes narrowing of the aortomesenteric angle. The vomiting and obstructive syndrome is then self-perpetuated regardless of the initiating factors. The young age and nonspecific symptoms often lead to a delay in diagnosis.

Discussion

A series of eight cases is presented reviewing the presentation, investigations, surgical treatment by division of duodenum and duodenojejunostomy, and outcomes.

Conclusion

SMA syndrome is a well-described entity which must be considered as a cause of vomiting associated with significant weight loss in young adults. Surgical treatment should be allied with psychological assessment to treat any underlying psychosocial abnormality.

This is a preview of subscription content, access via your institution.

Figure 1
Figure 2
Figure 3
Figure 4

References

  1. Geer MA. Superior mesenteric artery syndrome. Mil Med 1990;155:321–323.

    PubMed  CAS  Google Scholar 

  2. Wilkie DP. Chronic duodenal ileus. Am J Med Sci 1927;173:643–649. doi:10.1097/00000441-192705000-00006.

    Article  Google Scholar 

  3. Derrick JR, Fadhli HA. Surgical anatomy of the superior mesenteric artery. Am Surg 1965;31:545–547.

    PubMed  CAS  Google Scholar 

  4. Neri S, Signorelli SS, Mondati E, Pulvirenti D, Campanile E, Di Pino L, et al. Ultrasound imaging in diagnosis of superior mesenteric artery syndrome. J Intern Med 2005;257:346–351.

    PubMed  CAS  Google Scholar 

  5. Sapkas G, O’Brien JP. Vascular compression of the duodenum (cast syndrome) associated with the treatment of spinal deformities. A report of six cases. Arch Orthop Trauma Surg 1981;98:7–11. doi:10.1007/BF00389703.

    PubMed  Article  CAS  Google Scholar 

  6. Zhu ZZ, Qiu Y. Superior mesenteric artery syndrome following scoliosis surgery: its risk indicators and treatment strategy. World J Gastroenterol 2005;11:3307–3310.

    PubMed  Google Scholar 

  7. Lippl F, Hannig C, Weiss W, Allescher HD, Classen M, Kurjak M. superior mesenteric artery syndrome: diagnosis and treatment from the gastroenterologist’s view. J Gastroenterol 2002;37:640–643. doi:10.1007/s005350200101.

    PubMed  Article  Google Scholar 

  8. Reckler JM, Bruck HM, Munster AM, Curreri PW, Pruitt BA. Superior mesenteric artery syndrome as a consequence of burn injury. J Trauma 1972;12:979–985. doi:10.1097/00005373-197211000-00008.

    PubMed  Article  CAS  Google Scholar 

  9. Adson DE, Mitchell JE, Trenkner SW. The superior mesenteric artery syndrome and acute gastric dilatation in eating disorders: a report of two cases and a review of the literature. Int J Eat Disord 1997;21:103–114. doi:10.1002/(SICI)1098-108X(199703)21:2<103::AID-EAT1>3.0.CO;2-P.

    PubMed  Article  CAS  Google Scholar 

  10. Barnes JB, Lee M. Superior mesenteric artery syndrome in an intravenous drug abuser after rapid weight loss. South Med J 1996;89:331–334. doi:10.1097/00007611-199603000-00015.

    PubMed  Article  CAS  Google Scholar 

  11. Neto NI, Godoy EP, Campos JM, Abrantes T, Quinino R, Barbosa AL, et al. Superior mesenteric artery syndrome after laparoscopic sleeve gastrectomy. Obes Surg 2007;17:825–827. doi:10.1007/s11695-007-9125-z.

    PubMed  Article  Google Scholar 

  12. Smith BM, Zyromski NJ, Purtill MA. Superior mesenteric artery syndrome: an under recognized entity in the trauma population. J Trauma 2008;64(3):827–830.

    PubMed  Article  Google Scholar 

  13. Biank V, Werlin S. Superior mesenteric artery syndrome in children: a 20 year experience. J Pediatr Gastroenterol Nutr 2006;42:522–525. doi:10.1097/01.mpg.0000221888.36501.f2.

    PubMed  Article  Google Scholar 

  14. Ylinen P, Kinnunen J, Hockerstedt K. Superior mesenteric artery syndrome. A follow up study of 16 operated patients. J Clin Gastroenterol 1989;11:386–391. doi:10.1097/00004836-198908000-00007.

    PubMed  Article  CAS  Google Scholar 

  15. Fromm S, Cash JM. Superior mesenteric artery syndrome: an approach to the diagnosis and management of upper gastrointestinal obstruction of unclear aetiology. S D J Med 1990;43:5–10.

    PubMed  CAS  Google Scholar 

  16. Hines JR, Gore RM, Ballantyne GH. Superior mesenteric artery syndrome. Diagnostic criteria and therapeutic approaches. Am J Surg 1984;148:630–632. doi:10.1016/0002-9610(84)90339-8.

    PubMed  Article  CAS  Google Scholar 

  17. Applegate GR, Cohen AJ. Dynamic CT in superior mesenteric artery syndrome. J Comput Assist Tomogr 1988;12:976–980. doi:10.1097/00004728-198811000-00013.

    PubMed  Article  CAS  Google Scholar 

  18. Unal B, Aktas A, Kemal G, Bilgili Y, Guliter S, Daphan C, et al. Superior mesenteric artery syndrome: CT and ultrasonography findings. Diagn Interv Radiol 2005;11:90–95.

    PubMed  Google Scholar 

  19. Strong EK. Mechanics of arteriomesentric duodenal obstruction and direct surgical attack upon etiology. Ann Surg 1958;148:725–730. doi:10.1097/00000658-195811000-00001.

    PubMed  Article  CAS  Google Scholar 

  20. Stavely AL. Acute and chronic gastromesenteric ileus with cure in a chronic case by duodenojejeunostomy. Bull Johns Hopkins Hosp 1908;19:252.

    Google Scholar 

  21. Lee CS, Mangla JC. Superior mesenteric artery compression syndrome. Am J Gastroenterol 1978;70:141–150.

    PubMed  CAS  Google Scholar 

  22. Massoud WZ. Laparoscopic management of superior mesenteric artery syndrome. Int Surg 1995;80:322–327.

    PubMed  CAS  Google Scholar 

  23. Richardson WS, Surowiec WJ. Laparoscopic repair of superior mesenteric artery syndrome. Am J Surg 2001;181:377–378. doi:10.1016/S0002-9610(01)00571-2.

    PubMed  Article  CAS  Google Scholar 

  24. Martin RJ, Khor TS, Vermeulen T, Hall J. Wilkie syndrome may be due to poor motility. ANZ J Surg 2005;75:1027. doi:10.1111/j.1445-2197.2005.03603.x.

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to N. D. Merrett.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Merrett, N.D., Wilson, R.B., Cosman, P. et al. Superior Mesenteric Artery Syndrome: Diagnosis and Treatment Strategies. J Gastrointest Surg 13, 287–292 (2009). https://doi.org/10.1007/s11605-008-0695-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0695-4

Keywords

  • Superior mesenteric artery syndrome
  • Cast syndrome
  • Wilkie’s syndrome
  • Duodenal obstruction
  • Strong’s procedure
  • Laparoscopy
  • Duodenojejunal bypass