Superior mesenteric artery syndrome: Diagnostic criteria and therapeutic approaches

doi:10.1016/0002-9610(84)90339-8

The American Journal of Surgery

Volume 148, Issue 5, November 1984, Pages 630-632

https://doi.org/10.1016/0002-9610(84)90339-8 Get rights and content

Abstract

The hospital records and radiographs of 44 patients diagnosed as having superior mesenteric artery syndrome were reviewed using strict clinical and radiographie criteria. Only six (14.6 percent) of the patients fulfilled these criteria, suggesting overdiagnosis of the disorder. An acute change in clinical status, such as an operation or complication of a medical disease, appeared to precipitate the superior mesenteric artery syndrome in these patients, all of whom had chronic debilitating diseases. In four of the six patients conservative therapy failed, and they required surgical decompression.

References (18)

JR Derrick et al.
Surgical anatomy of the superior mesenteric artery
Am Surg
(1965)
CV Cimmino
Superior mesenteric artery syndrome
NY State J Med
(1976)
SB Eaton et al.
Radiology of the pancreas and duodenum
CH Fagge
Acute dilatation of the stomach
Guy's Hospital, Series 3
(1873)
JT Akin et al.
Vascular compression of the duodenum: presentation of ten cases and review of the literature
Surgery
(1976)
CR Mansberger et al.
Vascular compression of the duodenum: emphasis on accurate diagnosis
Am J Surg
(1970)
E Wayne et al.
Duodenal obstruction by the superior mesenteric artery in bedridden combat casualties
Ann Surg
(1971)
B Gondos
Duodenal compression defect and the “superior mesenteric artery syndrome”
Radiology
(1977)
PJ Lukes et al.
Diagnostic value of hypotonie duodenography in superior mesenteric artery syndrome
Acta Chir Scand
(1978)

There are more references available in the full text version of this article.

Cited by (169)

Superior mesenteric artery syndrome following lung cancer surgery: A case report
2023, International Journal of Surgery Case Reports
Superior mesenteric artery syndrome (SMAS) is a rare medical condition resulting from vascular compression of the third part of the duodenum in the angle between the aorta and the superior mesenteric artery, leading to partial or complete intestinal obstruction and causing a series of symptoms. We now introduce a case of SMAS after lung cancer surgery, which was unique in that it was most likely caused by weight loss after surgery.
A 58-year-old male patient gradually developed severe nausea, vomiting, and weight loss after lung cancer surgery. A diagnosis of SMAS was made after the computed tomography of the abdomen was performed. The patient's symptoms were relieved after immediate placement of a nasojejunal nutrition tube for gastrointestinal decompression and enteral nutrition support.
SMAS is rare and the symptoms are not specific, the clinical diagnosis of it is mostly confirmed by imaging. The presence of SMAS should be considered as a possibility when recurrent nausea and vomiting occur after lung surgery that excludes the above-mentioned causes.
The signs and symptoms of SMAS are usually non-specific, which leads to misdiagnosis in all probability. SMAS should be considered when unexplained significant weight loss accompanied by recurrent nausea and vomiting happens to postoperative patients.
Point-of-care ultrasound findings in the diagnosis and management of Superior Mesenteric Artery (SMA) syndrome
2022, American Journal of Emergency Medicine
Superior mesenteric artery (SMA) syndrome is a potentially fatal condition that can be difficult to diagnose for emergency medicine physicians due to its rarity and vague gastrointestinal symptom presentation. Patients arriving at the emergency department (ED) with this condition may encounter delays in proper supportive care and treatment. We present the case of a 21-year-old female who was seen in the ED for nausea, non-bloody vomiting, and rapid weight loss. Through point-of-care ultrasound (POCUS) findings, she was diagnosed with SMA syndrome and received appropriate, supportive care for her condition before catastrophic complications could occur. This case demonstrates the utility of POCUS in SMA syndrome and the importance of considering this diagnosis despite its rarity.
Postoperative superior mesenteric artery syndrome following appendicectomy: A case report
2022, International Journal of Surgery Case Reports
Citation Excerpt :
It has been described in the literature by a variety of other names, including Cast syndrome, Wilkie syndrome, arteriomesenteric duodenal obstruction, and chronic duodenal ileus [1,2]. This rare, but potentially life-threatening syndrome often presents a diagnostic challenge where symptoms do not always correlate well with radiologic studies [3,4]. This case has been reported in line with the SCARE Criteria 2020 [5].
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.
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.
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.
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.
Vomiting and Nausea
2020, Pediatric Gastrointestinal and Liver Disease, Sixth Edition
It is accepted that the ability to vomit developed as a protective mechanism to rid the body of ingested toxins Unfortunately vomiting also frequently occurs unrelated to the ingestion of noxious agents, a circumstance that produces several clinical challenges. First, vomiting can be a sign of many diseases that affect different organ systems. Therefore, determining the cause of a vomiting episode can be difficult. On the other hand, vomiting can be present in a patient without any evidence of an underlying inflammatory, anatomic, neoplastic, or metabolic process. Second, vomiting can produce several complications (e.g., electrolyte derangement, prolapse gastropathy, and blood loss) that demand diagnosis and treatment. Third, vomiting is a frequent complication of medical therapy (surgical procedures, cancer chemotherapy). Fourth, selection of appropriate therapy for this distressing problem is essential to improve patient comfort and avoid the additional medical complications associated with the vomiting.
Abdominal Pain Presenting as a Tight Squeeze on a Tchaikovsky Score
2019, Gastroenterology
A rare cause of upper gastrointestinal system obstruction: Superior mesenteric artery syndrome (Wilkie's syndrome); two different case reports
2024, Turkish Journal of Surgery

View all citing articles on Scopus

¹: From the Departments of Surgery and Radiology, Northwestern University Medical School, Chicago, Illinois.

View full text

Scientific paperSuperior mesenteric artery syndrome: Diagnostic criteria and therapeutic approaches

Abstract

Surgical anatomy of the superior mesenteric artery

Am Surg

Superior mesenteric artery syndrome

NY State J Med

Radiology of the pancreas and duodenum

Acute dilatation of the stomach

Guy's Hospital, Series 3

Vascular compression of the duodenum: presentation of ten cases and review of the literature

Surgery

Vascular compression of the duodenum: emphasis on accurate diagnosis

Am J Surg

Duodenal obstruction by the superior mesenteric artery in bedridden combat casualties

Ann Surg

Duodenal compression defect and the “superior mesenteric artery syndrome”

Radiology

Diagnostic value of hypotonie duodenography in superior mesenteric artery syndrome

Acta Chir Scand

Scientific paper
Superior mesenteric artery syndrome: Diagnostic criteria and therapeutic approaches