[Superior mesenteric artery syndrome]

[Early form of Wilkie's syndrome: a rare complication of scoliosis surgery, about a case and review of the literature]

Le syndrome de la pince aorto-mésentérique est une complication rare pouvant survenir après une correction chirurgicale de scoliose. Les phénomènes de traction verticale de l’artère mésentérique et le rétrécissement de l’angle aorto-mésentérique lors de la correction sont à l’origine de ce syndrome par compression du troisième duodénum. Nous rapportons ici l’observation d’un cas précoce de syndrome de la pince aorto-mésentérique secondaire à une correction chirurgicale d’une scoliose idiopathique chez une fille. Une jeune fille opérée d’une arthrodèse vertébrale postérieure pour une scoliose idiopathique avait présenté au troisième jour postopératoire des vomissements incoercibles avec arrêt des matières et des gaz. Le scanner abdominal réalisé en urgence avait permis le diagnostic d’un syndrome de l’artère mésentérique supérieure. La prise en charge consistait à une mise au repos du tube digestif associé à une nutrition parentérale précoce et une correction des déséquilibres hydroélectrolytiques. Devant l’absence d’amélioration clinique, l’indication opératoire fut posée. L’évolution a été favorable avec des suites opératoires simples et une reprise alimentaire orale à quatrième jour, une sortie à domicile au septième jour postopératoire.Les facteurs favorisants sont les sujets jeunes, de morphotype longiligne avec un faible IMC inférieur à 18.Les signes scannographiques sont une dilatation gastrique importante avec un arrêt net au niveau de 3ème duodénum. La prise en charge est multidisciplinaire étant médicale d’abord et chirurgicale en cas d’échec. Une meilleure connaissance des facteurs prédictifs d’échec du traitement médical permettrait de réduire la durée de séjour hospitalier.

Superior mesenteric artery syndrome: an infrequent complication of scoliosis surgery

Superior mesenteric artery syndrome is a rare condition that causes a proximal small intestinal obstruction due to contraction of the angle between the superior mesenteric artery and the aorta. Scoliosis surgery is one of the 15 reasons for superior mesenteric artery syndrome, which can present with acute or chronic manifestations. Although conservative treatment is usually possible, surgical treatment is required in certain cases that cannot be treated using conservative methods. In this paper, we describe a patient who developed superior mesenteric artery syndrome after scoliosis surgery and was treated with duodenojejunostomy due to failure and complications of conservative treatment.

[Aorto-mesenteric compression syndrome in children: report of a case]

Le syndrome de la pince aorto-mésentérique résulte de la compression du troisième duodénum entre l'artère mésentérique supérieure et l'aorte. Elle détermine un tableau d'occlusion intestinale haute aiguë ou chronique. Nous faisons une revue de la littérature à partir d'un cas de syndrome de la pince aorto-mésentérique. Il s'agit d'un nourrisson de 16 mois suivi pour des vomissements alimentaires évoluant depuis l’âge de 03 mois et rebelles au traitement médical. Il s'agit de vomissements postprandiaux tardifs d'apparition intermittente, améliorés par la position de décubitus ventral. Le bilan radiologique composé d'une radiographie de l'abdomen sans préparation, d'un transit oeso-gastroduodénal (TOGD) et d'un angioscanner a permis d'aboutir au diagnostic d'obstruction extrinsèque et incomplète du 3ème duodénum par la pince aorto-mésentérique. Une dérivation interne par duodéno-jéjunostomie sur anse en oméga a permis de contourner l'obstacle vasculaire avec des suites simples. Le TOGD de contrôle du 9ème jour postopératoire a montré une bonne perméabilité de l'anastomose duodéno-jéjunale. Les vomissements ont disparu et on note un gain pondéral de 2 kg en 3 mois. Les vomissements chroniques chez le nourrisson sont d’étiologies variées. L'obstacle siégeant au 3ème duodénum est le plus souvent dû à une pince aorto-mésentérique. Malheureusement ce diagnostic est rarement porté surtout en Afrique probablement du fait de l'insuffisance des moyens diagnostiques en particulier dans les zones reculées. Le traitement peut être fait par les moyens chirurgicaux ou nutritionnels.

Superior mesenteric artery syndrome and its associated gastrointestinal implications

The superior mesenteric artery (SMA) syndrome is a rare but potentially life-threatening gastrointestinal condition. Over the years, it has been referenced by several names, the most common of which is Wilkie's syndrome. These numerous terminologies have made it difficult to estimate its true frequency in the general population. Common symptoms associated with this syndrome include intermittent postprandial abdominal pain, nausea, and bilious vomiting. Our review revealed that although it is currently well-defined in the literature, the diagnosis of SMA syndrome remains challenging as other disorders can mimic its presentation. However, CT angiography is currently favored in the literature for diagnosis as it can not only show the narrowed aorto-mesenteric angle and distance, but also the extent of duodenal obstruction. In addition, we found no consensus on the preferred mode of therapy once SMA syndrome is diagnosed. The agreement among authors is that the treatment options should be based on severity of the disease, using conservative measures as the first line of therapy in mild SMA syndrome. Duodenojejunostomy is the preferred surgical approach when conservative management fails, or in severe cases.

[Superior mesenteric artery syndrome: a case report]

Superior mesenteric artery syndrom is a condition triggered by the compression of the third portion of the duodenum between the superior mesenteric artery and the aorta.

OBSERVATIONS

A twenty-one year old woman with a significant past history of neurological disease was referred for bilious vomiting and epigastric pain. The diagnosis of superior mesenteric artery syndrom was established by abdominal CT-scan. A laterolateral duodenojejunostomy was performed by laparotomy. After six months follow-up, this patient was asymptomatic.

CONCLUSION

Superior mesenteric artery syndrom can be easily diagnosed by abdominal CT-scan. Diagnosis and management of this infrequent syndrom are reviewed.

[Superior mesenteric artery syndrome: a cause of vomiting in children. Report of 3 cases]

Duodenal obstruction by Superior Mesenteric Artery (SMA) is a misdiagnosed vomiting syndrome in children. Several factors are involved, including rapid weight loss, rapid statural growth without weight augmentation. Diagnosis is suspected when an improvement is achieved by ventral decubitus and it is confirmed by plain films of the abdomen, GI study with barium and echography, measuring the aortomesenteric angle (inferior to 25-30 degrees ). Patients must at first be treated conservatively. Surgery is indicated for occlusive episodes with unsuccessful conservative therapy. The authors report 3 cases with different clinical presentation. However, all the patients presented important weight loss and vomiting.

Ultrasound imaging in diagnosis of superior mesenteric artery syndrome

OBJECTIVES

We screened a cohort of subjects affected by various degree of dyspepsia to reveal if they presented a reduction of the aorto-mesenteric angle and to diagnose suspected cases of superior mesenteric artery (SMA) syndrome.

DESIGN

Controlled, prospective, study.

SETTING

Subjects were studied as outpatients.

SUBJECTS

The study investigated a total of 3622 subjects referred to our department by their general practitioners for dyspepsia and/or abdominal pain. Interventions. Abdominal ultrasonography with power colour Doppler, gastroduodenoscopy, hypotonic duodenography, contrast-enhanced spiral computerized tomography were performed. MAIN OUTCOME MEASUREMENT AND RESULTS: Color Doppler revealed a significant reduction of the SMA angle in 29 of 950 subjects; gastroscopy showed duodenal compressive pulsation in 14 of 29 patients and X-ray revealed compression of the third segment of the duodenum in 28 of 29 patients. CT confirmed the presence of a reduced angle and various degrees of duodenal compression in all patients. Ultrasonography and CT examinations gave overlapping results (P > 0.05) in diagnosing pathological aorto-mesenteric angle.

CONCLUSION

The authors believe that the incidence of reduced aorto-mesenteric angle and SMA syndrome might be underrated. Ultrasound power colour Doppler imaging is useful in epidemiological screening of reduced aorto-mesenteric angle to diagnose suspected cases of SMA syndrome.

Late superior mesenteric artery syndrome in paraplegia: case report and review

STUDY DESIGN

A case report of superior mesenteric artery syndrome (SMA syndrome) occurring in a paraplegic patient 3 months after injury.

OBJECTIVES

To report an unusual case and review the literature of SMA syndrome in spinal cord injured patients, focusing on paraplegic subjects and on tardive presentations.

SETTING

A Physical Medicine and Rehabilitation Center in Garches (France).

METHOD

Current medical literature includes reports of only 14 spinal cord injured patients with SMA syndrome. This syndrome has been often described in anorexia nervosa, burns or other causes of cachexia, following correction of spinal deformities or after application of body casts.

RESULTS

In spinal cord injured patients SMA usually occurs in tetraplegic patients during the first weeks after injury. Only four cases of SMA syndrome in paraplegic patients have been described. Late forms are less common than acute ones: only three cases among 14. SMA syndrome consists of a vascular compression of the third part of the duodenum between the ventrally oriented SMA and the aorta. The normal aorto-mesenteric angle ranges between 38 degrees and 65 degrees and can be as low as 6 degrees in patients with SMA syndrome. The diagnosis is usually based on upper gastro-intestinal contrast X-ray study, which shows abrupt vertical compression of the third part of the duodenum. CT scan with angiography is useful in some difficult cases. Conservative management includes early correction of dehydration and electrolyte imbalance, insertion of a nasojejunal tube beyond the obstruction and renutrition. Duodenojejunostomy may be necessary in case of failure of conservative treatment.

CONCLUSION

SMA syndrome is an unusual gastro-intestinal complication that may occur in paraplegic patients, even late after injury.