Coexistant superior mesenteric artery syndrome and. Superior mesenteric artery syndrome after endtoside. The vomiting and obstructive syndrome is then self. For example, one report stated that a few sites of severe gastric dilatation were secondary to pyloric spasms. Superior mesenteric artery syndrome radiology case. International journal of science and research ijsr is published as a monthly journal with 12 issues per year. Im not really sure if this is the discussion that this syndrome would fall under. It has reported that the prevalence of sma syndrome was approximately 0. However, surgery is often the only solution that can improve quality of life. Superior mesenteric artery syndrome mimicking and complicating crohn. Superior mesenteric artery syndrome postgraduate medical journal. Sma syndrome can have many presentations often with small bowel obstruction. Superior mesenteric artery syndrome in a tetraplegic patient. Suspicion of superior mesenteric artery syndrome in a.
Superior mesenteric artery sma syndrome is caused by extrinsic compression of the duodenum, which is trapped between the sma anteriorly and the aorta posteriorly as the sma crosses over the duodenum in the root of the mesentery. It has been referred to by a variety of other names, including cast syndrome, wilkie syndrome, arteriomesenteric duodenal obstruction, and chronic duodenal ileus. Pdf superior mesenteric artery sma syndrome is a rare acquired disorder in which an acute angulation of sma causes compression. A number of factors have been described causing this syndrome. Health, general arterial occlusions care and treatment case studies diagnosis arterial occlusive diseases gastrointestinal diseases. Any disease process decreasing the angle between the superior mesenteric artery and the abdominal aorta can result in the external compression of the. Mar 10, 2015 superior mesenteric artery syndrome smas after a surgical operation is very rare. The superior mesenteric artery arises from the anterior aspect of the aorta at the level of the l1 vertebral body. Direct venography revealed a large ovarian varix that was treated with hysterectomy and unilateral oophorectomy. Computed tomography features and surgical treatment of. If you have problems viewing pdf files, download the latest version of adobe reader.
Superior mesenteric artery syndrome improved by enteral. Superior mesenteric artery syndrome is a suspected cause of such dilatation. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Superior mesenteric artery syndrome smas is a very rare manifestation of. The smasras, as available, on a quarterly basis will distribute grants. Superior mesenteric artery sma syndrome is a rare clinical entity that results from vascular compression of the third portion of the duodenum between the angle of the abdominal aorta and the sma. Superior mesenteric artery syndrome 417 lee, mangla 1978.
Superior mesenteric artery syndrome smas is a rare condition caused by compression of the third part of the duodenum between the superior mesenteric artery. Superior mesenteric artery sma syndrome, also known as wilkie syndrome or cast syndrome or aortomesentric duodenal compression syndrome is a rare acquired vascular compression disorder in which acute angulation of the superior mesenteric artery sma results in compression of the third part of the duodenum, leading to obstruction. Amazon prime days is coming up and its a great time to help the nonprofit raise a little money. Clinical and radiological considerations for idiopathic smas download. Notably, it is a referred, highly indexed, online international journal with high impact factor. Superior mesenteric artery syndrome as a rare cause of duodenal obstruction. Superior mesenteric artery sma syndrome is an unusual but wellrecognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum against the aorta by the sma or leaf of the mesentery, and results in chronic, intermittent, or acute duodenal obstruction. This rare, potentially lifethreatening syndrome is typically caused by an angle of 625 between the aa and the sma, in comparison to the normal range of 3856, due to.
Research articles superior mesenteric artery syndrome. The superior mesenteric artery sma syndrome is a rare entity presenting. Superior mesenteric artery syndrome radiology reference. This compression causes partial or complete blockage of the duodenum. It presents with clinical features of upper gastrointestinal obstruction and is attributed to extrinsic compression of the third part of the duodenum between the aorta posteriorly and the superior mesenteric artery anteriorly decrease in aortomesenteric angle. The superior mesenteric artery sma syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Radiologically, the findings were in keeping with a superior mesenteric artery sma syndrome. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Superior mesenteric artery sma syndrome was first described by professor rokitansky in 1842 1, 2. A 74yearold asian woman underwent total colectomy, ileal pouchanal anastomosis jpouch, covering ileostomy, splenectomy, and distal pancreatectomy for treatment of. In the patients with sma syndrome, the third portion transverse part of the duodenum is compressed externally between the sma and abdominal aorta aa leading to duodenal. Mesenteric artery aneurysm an overview sciencedirect.
Superior mesenteric artery syndrome after severe head trauma. Superior mesenteric artery syndrome symptoms, treatment. Ct or ct angiogram is also superior to ultrasound because it can measure the reduced aortomesenteric angle and sh ow the gastric and duod enal dilatation at. Radiological case of the month gastroenterology jama. Superior mesenteric artery syndrome smas, also known as wilkies syndrome, aortomesenteric compression, arteriomesenteric duodenal compression or duodenal vascular compression is a rare condition that results from vascular compression of the third part of the duodenum, in the angle between the aorta and the superior mesenteric artery. Familial superior mesenteric artery syndrome springerlink. The compression is usually just to the right of midline, where it produces a. Superior mesenteric artery syndrome smas is a digestive condition that occurs when the duodenum the first part of the small intestine is compressed between two arteries the aorta and the superior mesenteric artery. Superior mesenteric artery sma syndrome, also known as wilkies syndrome or benign duodenal stasis, is a rare benign disease. Superior mesenteric artery syndrome as a cause of acute. We report a female patient presenting with abdominopelvic pain and diagnosed with superior mesenteric artery syndrome. Treatment can be conservative, with the aim of regaining normal. Superior mesenteric artery syndrome is a rare cause of. Symptoms vary based on severity, but can be severely debilitating.
Smas a prospective study in a single institution italy 2018 download. Superior mesenteric artery sma syndrome is described as compression of the third part of the duodenum between sma and aorta with resultant obstruction and dilatation of proximal duodenum and stomach. Based on the clinical and imaging findings, a diagnosis of superior mesenteric artery sma syndrome was made. Superior mesenteric artery syndrome is a rare and controversial form of upper intestinal obstruction in which the third part of the duodenum is compressed by the overlying superior mesenteric artery.
Superior mesenteric artery syndrome genetic and rare. We experienced an extremely rare case of ileal pouchanal anastomosis with subsequent development of smas requiring duodenojejunostomy. A diagnosis of superior mesenteric artery syndrome was made. Superior mesenteric artery syndrome in a healthy active.
Pals patient airlift services patient airlift services. Plain ct showed gastric and duodenal distension with abrupt narrowing at the third portion of the duodenum, with the superior mesenteric artery sma crossing anterior to the transition point figure 1a. The aim of the present study was to verify that duodenal anatomy mimicking sma syndrome is a risk factor for duodenal involvement and abdominal pain in hsp. Any disease process decreasing the angle between the. Fig the course of third part of duodenum inbetween aorta and superior mesenteric artery. Only 12 cases of superior mesenteric artery syndrome in the young have been reported in the literature available to the authors.
Computed tomography ct scan schowed a compression of the duodenum between the aorta and sma fig 2 and the aortomesenteric angle was lower. Duodenal derotation as an effective treatment of superior mesenteric artery syndrome. This results in chronic, intermittent, or acute complete or partial duodenal obstruction. Superior mesenteric artery syndrome is an uncommon cause of high gastrointestinal tract obstruction, and should be suspected when endoscopic examination does not reveal an intrinsic obstruction. Diagnosis superior mesenteric artery syndrome an abdominal computed tomography ct scan with contrast revealed the narrowing of the third portion of the duodenum compressed by the superior mesenteric artery sma, with dilation of the. Superior mesenteric artery syndrome statpearls ncbi bookshelf. Purpose superior mesenteric artery syndrome smas refers to the compression of the third portion of the duodenum between the aorta and the superior mesenteric artery, and usually results from. Pdf superior mesenteric artery syndrome as a rare cause. Occasionally, this disorder is seen after body casting or corrective spinal surgery. Late superior mesenteric artery syndrome in paraplegia. Superior mesenteric artery an overview sciencedirect.
Superior mesenteric artery syndrome and the nutcracker. Wilkies syndrome or superior mesenteric artery syndrome. Page 3 of 18 purpose introduction superior mesenteric artery sma syndrome is a relatively rare condition caused by obstruction of the third portion of the duodenum between the sma and aorta fig 1. Superior mesenteric artery syndrome has been described since the 1800s. Pressure on the inferior vena cava ivc and aorta decreases cardiac output which compromises distal blood flow, resulting in abdominal compartment syndrome with ischemia and renal. Mar 30, 2010 superior mesenteric artery syndrome is characterized by postprandial epigastric pain, eructation, fullness and vomiting.
Superior mesenteric artery syndrome in severe anorexia. Superior mesenteric artery syndrome research awareness and. It could threaten the life if the manifestation is severe and the treatment is inappropriate. This revealed a markedly dilated stomach and duodenum, with an abrupt cut off at the level of the third part of duodenum fig 1. The clinical picture is caused by compression of the 3rd part of the duodenum between the sma and aorta, which exert a clamlike or striding action on it. Case discussion superior mesenteric artery syndrome. The nutcracker syndrome should be considered as an uncommon cause of haematuria, particularly when a left sided varicocoele is also present. The duodenum is frequently affected in henochschonlein purpura hsp. Superior mesenteric artery syndrome with abdominal.
This clinical condition is termed superior mesenteric artery syndrome sma syndrome. It has been referred to as wilkies syndrome, the cast syndrome and arteriomesenteric duodenal compression. The diagnosis is based on findings from imaging studies, including. Superior mesenteric artery syndrome smas is an uncommon cause of.
Cleveland clinic minimally invasive duodenojejunostomy for superior mesenteric artery syndrome download. This research article would be good to download and take along with you to doctor appointments to share with your doctor if you are not getting the care. Unusual manifestation of superior mesenteric artery. Superior mesenteric artery syndrome smas syndromes. Superior mesenteric artery syndrome smas, wilkie syndrome or cast syndrome is a rare condition that usually presents with symptoms of mid to upper gastrointestinal obstruction due to the compression of the duodenum between the abdominal aorta, posteriorly, and the superior mesenteric artery, anteriorly. Unusual manifestation of superior mesenteric artery syndrome. Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome. It is enveloped in fatty and lymphatic tissue and extends in a caudal direction at an acute angle into the mesentery. If you continue browsing the site, you agree to the use of cookies on this website. Superior mesenteric artery syndrome research awareness and support, bonham, texas. Superior mesenteric artery sma syndrome is a condition in which the duodenum becomes compressed between the sma and the aorta, resulting in bowel obstruction which subsequently compresses surrounding structures. The syndrome is characterized by compression of the third portion of the duodenum due to narrowing of the. The aim of this paper is to describe the presentation and clinical management of a patient with anorexia nervosa complicated by superior mesenteric artery syndrome and pancreatitis, and discuss the association between these conditions. Superior mesenteric artery sma syndrome also known as wilkies syndrome, chronic duodenal ileus, or cast syndrome occurs when the third portion of the duodenum is compressed between the sma and the aorta.
Superior mesenteric artery syndrome is a rare cause of proximal small bowel. Superior mesenteric artery syndrome is an unusual cause of proximal intestinal obstruction. The main treatment for small bowel adenocarcinoma is radical. Superior mesenteric artery syndrome smas is a relatively rare disease that involves bowel obstruction symptoms.
Superior mesenteric artery sma syndrome, also known as wilkie syndrome, is a rare acquired vascular compression disorder in which acute angulation of the superior mesenteric artery sma results in compression of the third part of the duodenum. Superior mesenteric artery syndrome jama jama network. To report on our experience with the management of sma syndrome, drawing the attention to its existence. Acute superior mesenteric artery syndrome and pancreatitis in. The four daughters also had radiographic studies supporting that diagnosis. A case report of superior mesenteric artery syndrome sma syndrome occurring in a paraplegic patient 3 months after injury. 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. Diagnostic techniques done for smas can be very hard and tricky. Superior mesenteric artery sma syndrome is a rare complication of severe malnutrition that leads to intestinal obstruction, causing postprandial epigastric abdominal pain and nausea. Superior mesenteric artery syndrome coexists with nutcracker.
Jun 14, 2018 superior mesenteric artery syndrome smas is a digestive condition that occurs when the duodenum the first part of the small intestine is compressed between two arteries the aorta and the superior mesenteric artery. We are a registered nonprofit with the ultimate goals of raising awareness of. Superior mesenteric artery syndrome in an intravenous drug abuser after rapid weight loss rnew advances in the basic and clinical gastroenterology 418 geer d 1990 superior mesenteric artery. Introduction superior mesenteric artery sma syndrome is a relatively rare condition caused by obstruction of the third portion of the duodenum between the sma and aorta fig 1. This report discusses a case of superior mesenteric artery sma syndrome in a previously healthy 15yearold boy with no weight loss or other common risk factors. Please share the word and ask your friends to shop through our link. The condition may be managed conservatively, though surgical treatment is sometimes required, perhaps partly to establish the diagnosis. Figure 1 axial contrastenhanced ct of the abdomen shows a grossly dilated stomach and proximal duodenum with an abrupt transition point red arrow.
A recent report describes two superior mesenteric artery aneurysms successfully treated with stent grafts. Grants will be available to those with a confirmed diagnosis of superior mesenteric artery syndrome smas. Apr 17, 2015 superior mesenteric artery syndrome abhilash slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Superior mesenteric artery syndrome smas is a rare condition caused by compression of the third part of the duodenum between the superior mesenteric artery sma and the aorta, causing symptoms. If clinical symptoms are mild, conservative treatment is implemented. Although sma syndrome is benign, it could threaten the life if the manifestation is severe and the treatment is inappropriate. In this report, we describe this underdiagnosed condition in a previously healthy young female.
For language access assistance, contact the ncats public information officer. Superior mesenteric artery an overview sciencedirect topics. The syndrome may be imitated or caused by an eating disorder and having to distinguish the two from each other is very important since misdiagnosis can be really dangerous. Superior mesenteric artery sma syndrome known as wilkies syndrome is a rare cause of upper gastrointestinal.
Some of the doctors that i have been going to since march 2009 thinks that i may have this syndrome. This study aims at analyzing the clinical presentation, diagnosis, and management of sma syndrome. Studies to determine the optimal methods of diagnosis and treatment are required. Primary adenocarcinoma of the small intestine presenting as. Any disease process decreasing the angle between the superior mesenteric artery and the abdominal aorta can result in the external compression of the duodenum and subsequent intestinal obstruction.
This familial clustering raises the possibility of a genetic predisposition to this symptom and radiographic complex. Laparoscopic treatment of superior mesenteric artery syndrome. This prospective registry aims to describe demographic. A reduction of fat around the third part of the duodenum can predispose the duodenum to compression and obstruction by the sma as it emerges from the abdominal aorta. The superior mesenteric artery syndrome smas is a rare form of intestinal obstruction. Superior mesenteric artery sma syndrome is a gastrovascular disorder in which the third and final portion of the duodenum is compressed between the abdominal aorta aa and the overlying superior mesenteric artery. Although a consensus exists that superior mesenteric artery syndrome consists of duodenal. Superior mesenteric artery sma syndrome often occurs in the setting of rapid weight loss and scoliosis corrective spinal surgery. The patient presented to the emergency department with acute bilious vomiting and epigastric pain after acute consumption of a meal and excessive quantities of water. Superior mesenteric artery sma syndrome is a rare clinical entity.
Pals patient airlift services patient airlift services pals arranges free air transportation for individuals requiring medical diagnosis, treatment or followup, for compassionate assistance, f. If conservative treatment fails, laparoscopic duodenojejunostomy should be done. Treatment usually is conservative but surgical intervention should be considered if that failed. Abdominal discomfort, pain, and vomiting of bilestained material constituted the majority of complaints, but the signs. Superior mesenteric artery sma syndrome is an uncommon but well recognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum between the aorta and the superior mesenteric artery.
Ct scan of the abdomen shows hugely distended stomach, first and second part of the duodenum, with transition zone at the origin of the sma, confirming the diagnosis of sma syndrome. Clinical report by journal of evolution of medical and dental sciences. Superior mesenteric artery sma syndrome, also known as wilkies syndrome and cast syndrome, is a rare gastrointestinal disease that leads to obstruction of the duodenum. Favorable minimal invasive surgery in the treatment of superior. Superior mesenteric artery sma syndrome is a rare condition of duodenal obstruction, caused by the overlying sma. Only relatively recently has it established itself as a disease entity. On physical examination, he was cachectic body mass index, 15. Purpose superior mesenteric artery syndrome smas refers to the compression of the third portion of the duodenum between the aorta and the superior mesenteric artery, and. Virtually, any condition associated with weight reduction may predispose the patient to sma syndrome.
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