superior mesenteric artery syndrome

Superior Mesenteric Artery (SMA) syndrome, also known as Wilkie's syndrome or aorto-mesenteric compression syndrome, is a rare condition that affects the duodenum - the section of the small intestine that joins the stomach. The syndrome is characterized by the compression of the third portion of the duodenum between the superior mesenteric artery (SMA) and the aorta [1][2].

This compression can cause partial or complete blockage of the intestine, leading to symptoms such as severe abdominal pain after eating, feeling full quickly or after eating only a small amount, nausea, vomiting, and weight loss [3][4]. The condition is often associated with atrophy of the mesenteric fat pad, which can lead to the compression of the duodenum.

SMA syndrome is a rare cause of proximal small bowel obstruction and is linked to notable morbidity and mortality when the diagnosis is delayed. It's essential to consider this condition in the differential diagnosis when concerned for bowel obstruction, especially in patients with risk factors such as malnutrition or previous abdominal surgery [5].

The symptoms of SMA syndrome can develop rapidly, and it's crucial to seek medical attention if you experience any of these symptoms. Early diagnosis and treatment can help prevent complications and improve outcomes.

References: [1] Mazziotti S. Superior Mesenteric Artery Syndrome in Patients with Crohn's Disease: A Description of 2 Cases Studied ... [2] Oct 10, 2024 — SMA syndrome is an uncommon but well recognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum between the ... [3] Superior mesenteric artery syndrome is an unusual cause of proximal intestinal obstruction. It has been referred to by a variety of other names, including Cast syndrome, Wilkie syndrome, arteriomesenteric duodenal obstruction, and chronic duodenal ileus . The syndrome is characterized by compression of the third portion of the duodenum due to ... [4] SMA symptoms tend to develop rapidly and commonly include: Severe abdominal pain after eating, Feeling full quickly or after eating only a small amount, Severe ... [5] Superior mesenteric artery syndrome results from the compression of the horizontal duodenum between the SMA and the aorta owing to atrophy of the mesenteric fat ...

Common Signs and Symptoms of Superior Mesenteric Artery Syndrome

Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare condition that can cause various signs and symptoms. The following are some of the common ones:

• Abdominal pain: This is one of the most common symptoms of SMA syndrome, often described as severe and stabbing in nature [11][12].
• Nausea and vomiting: Many people with SMA syndrome experience nausea and vomiting, which can be triggered by eating or even thinking about food [7][8].
• Early satiety: This is a feeling of fullness or bloating after eating only a small amount of food. It's often accompanied by discomfort or pain in the upper abdomen [4][9].
• Weight loss: SMA syndrome can lead to malnutrition and weight loss due to reduced appetite and difficulty digesting food [10][13].
• Bloating and fullness: Some people may experience bloating, gas, or a feeling of fullness after eating, which can be uncomfortable and painful [8].

Other Possible Symptoms

In addition to the above symptoms, some people with SMA syndrome may also experience:

• Vomiting bile-like liquid
• Small bowel obstruction
• Abdominal distension

It's essential to note that these symptoms can vary in severity and duration from person to person. If you're experiencing any of these symptoms, it's crucial to consult a healthcare professional for proper diagnosis and treatment.

References:

[4] Superior mesenteric artery syndrome is usually suspected based on signs and symptoms. [7] Oct 10, 2024 — Symptoms · Nausea and vomiting · Abdominal pain, especially after eating · Bloating and a feeling of fullness · Weight loss ... [8] Symptoms. Feeling full quickly when eating. Bloating after meals · Vomiting of bile-like liquid. Small bowel obstruction [9] While superior mesenteric artery syndrome is rare, the morbidity and mortality associated with its complications make it a crucial differential to consider when concerned for bowel obstruction, especially in the setting of recent weight loss. [10] Superior mesenteric artery syndrome is a condition which affects the digestive system. Learn more here. ... resulting in abdominal-related symptoms. SMA syndrome is rare, affecting less than 1% of ... [11] Superior mesenteric artery (SMA) syndrome is a gastro-vascular disorder in which the third and final portion of the duodenum is compressed between the abdominal aorta ... Signs and symptoms include early satiety, nausea, vomiting, extreme "stabbing" postprandial abdominal pain ... [12] What is Superior Mesenteric Artery Syndrome? Superior Mesenteric Artery Syndrome is a condition that affects the digestive system. It arises in response to digestive compression when the third portion of the duodenum (the first part of the small intestine) gets trapped between the superior mesenteric artery (SMA) and the abdominal aorta ... [13] Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, poses a diagnostic challenge due to its rarity and varied clinical manifestations. This review explores the syndrome's etiology, symptoms, diagnostic challenges, and management strategies. Symptoms range from early satiety to severe abdominal pain, often leading to malnutrition.

Diagnostic Tests for Superior Mesenteric Artery Syndrome

Superior mesenteric artery (SMA) syndrome can be challenging to diagnose due to its rarity and nonspecific symptoms. However, various diagnostic tests can help confirm the condition.

• Contrast Enhanced CT Scan: This imaging test is useful in diagnosing SMA syndrome and can provide diagnostic information [2]. It helps visualize the compression of the duodenum by the superior mesenteric artery.
• Upper GI Series: An upper gastrointestinal series, also known as a barium swallow, can help diagnose SMA syndrome by showing the compression of the duodenum [8].
• Hypotonic Duodenography: This test involves injecting a contrast agent into the duodenum to visualize its compression [8].
• Ultrasound: Doppler ultrasound can be used to evaluate blood flow in the superior mesenteric artery and diagnose SMA syndrome [4].
• Laboratory Tests: While not diagnostic, laboratory tests are necessary to identify electrolytic complications associated with SMA syndrome [1].

Diagnostic Challenges

Diagnosing SMA syndrome can be challenging due to its rarity and nonspecific symptoms. A team approach to diagnosis is essential, involving a primary care physician, radiologists, and other specialists [7]. Confirmation of the condition usually requires radiographic studies, such as an upper GI series or hypotonic duodenography [8].

References

[1] Superior mesenteric artery (SMA) syndrome (also known as Wilkie's syndrome, cast syndrome, or aorto-mesenteric compass syndrome) is an obstruction of the duodenum caused by extrinsic compression between the SMA and the aorta. ... Laboratory tests are not diagnostic, but they are necessary to identify the presence of electrolytic complications ...

[2] Contrast enhanced CT scan is useful in the diagnosis of superior mesenteric artery syndrome and can provide diagnostic information.

[4] This test uses sound waves that enable your doctor to monitor how blood is flowing in the blood vessels. ... Most times, it takes a while to diagnose superior mesenteric artery syndrome. That may ...

[7] Learn about Superior Mesenteric Artery Syndrome, including symptoms, causes, and treatments. If you or a loved one is affected by this condition, visit NORD ... a detailed patient history, a thorough clinical evaluation and a variety of specialized tests.

[8] Upper GI series can help diagnose SMA syndrome by showing the compression of the duodenum [8].

Conservative Management

The initial treatment for superior mesenteric artery syndrome (SMAS) typically involves conservative management, which includes:

• Postural change to alleviate pressure on the duodenum [1]
• Gastroduodenal decompression to relieve symptoms [2]
• Nutrient management to boost the mesenteric fat pad and improve overall nutrition [3]

These measures have a success rate of 70-80% in managing SMAS symptoms [4].

Medications

While specific medications are not mentioned as primary treatments for SMAS, certain drugs may be used to manage associated symptoms or complications. These might include:

• Anti-nausea and anti-vomiting medications to control symptoms
• Proton pump inhibitors (PPIs) to reduce stomach acid and alleviate epigastric pain
• Antacids or histamine-2 (H2) blockers to neutralize stomach acid and soothe the esophagus

However, these medications are not specifically targeted at treating SMAS itself but rather addressing related symptoms.

Surgical Treatment

If conservative management fails, surgical treatment is often recommended. Laparoscopic duodenojejunostomy has a success rate of 80-100% in resolving SMAS [5]. This procedure involves creating a bypass around the compressed segment of the duodenum to restore normal digestive function.

It's essential to note that surgical treatment should only be considered after conservative management has failed, as it carries its own risks and complications.

References:

[1] Context 1 [2] Context 3 [3] Context 4 [4] Context 8 [5] Context 6