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Lamport L, DiMauro JP, Johnson S, Roberts S, Ziegler J. Association between underweight status or low body mass index and the risk of developing superior mesenteric artery syndrome following scoliosis corrective surgery in pediatric patients: a review of the literature. Spine Deform 2024:10.1007/s43390-024-00929-5. [PMID: 39046665 DOI: 10.1007/s43390-024-00929-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024]
Abstract
Superior mesenteric artery (SMA) syndrome is the compression of the third portion of the duodenum between the abdominal aorta and the superior mesenteric artery. Although multifactorial, the most frequent cause of SMA syndrome is significant weight loss and cachexia often induced by catabolic stress. SMA syndrome resulting from scoliosis surgery is caused by a reduction of the aortomesenteric angle and distance. Risk factors include rapid weight loss, malnutrition, and a rapid reduction in the mesenteric fat pad and are the most common causes of a decrease in the aortomesenteric angle and distance. Surgically lengthening the vertebral column can also lead to a reduction of the aortomesenteric distance, therefore, has been identified as a risk factor unique to spinal surgery. Despite a reported decline in SMA syndrome cases due to improved surgical techniques, duodenal compression is still a risk and remains a life-threatening complication of scoliosis surgery. This article is a cumulative review of the evidence of being underweight or having a low body mass index as risk factors for developing SMA syndrome following surgical scoliosis instrumentation and correction.
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Affiliation(s)
- Lyssa Lamport
- Cohen Children's Medical Center of New York, New Hyde Park, New York, USA.
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Newark, New Jersey, USA.
| | - Jon-Paul DiMauro
- Cohen Children's Medical Center of New York, New Hyde Park, New York, USA
- Zucker School of Medicine at Hofstra/Northwell, Orthopedic Surgery, Hempstead, New York, USA
| | - Stephani Johnson
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Susan Roberts
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Jane Ziegler
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
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2
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Tse A, Phan N, Ayoubi S, Fenton-Lee D. Necrotic mega-stomach from superior mesenteric artery syndrome. J Surg Case Rep 2024; 2024:rjae463. [PMID: 39036767 PMCID: PMC11260180 DOI: 10.1093/jscr/rjae463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/27/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
Superior mesenteric artery (SMA) syndrome is a rare cause of proximal bowel obstruction due to duodenal compression by the SMA. The morbidity and mortality associated with delayed diagnosis and its complications make it an important differential cause for bowel obstruction. We report a case of mega-stomach secondary to SMA syndrome requiring total gastrectomy. An 18-year-old male presented with vomiting, abdominal pain and shock after a buffet. Computed tomography (CT) imaging revealed a grossly distended stomach (113 × 187 × 350mm) and a transition point at the third part of the duodenum, along with pneumatosis and portal venous gas. Emergency gastroscopy showed blood and necrotic mucosa. Laparotomy confirmed full thickness necrosis and the patient underwent a total gastrectomy with Roux-en-Y reconstruction. Postoperatively, he had a brief intensive care stay and recovered without complications. This case underscores the importance of considering SMA syndrome during presentations of acute gastric dilatation.
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Affiliation(s)
- Andrew Tse
- Department of Surgery, St Vincent’s Hospital Sydney, 390 Victoria St, Darlinghurst, Sydney, New South Wales, 2010, Australia
- St Vincent’s Clinical School, University of New South Wales, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Natalie Phan
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Melbourne, Victoria, 3800, Australia
| | - Salah Ayoubi
- Department of Surgery, St Vincent’s Hospital Sydney, 390 Victoria St, Darlinghurst, Sydney, New South Wales, 2010, Australia
| | - Douglas Fenton-Lee
- Department of Surgery, St Vincent’s Hospital Sydney, 390 Victoria St, Darlinghurst, Sydney, New South Wales, 2010, Australia
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Sapkota D, Adhikari BB, Shrestha A, Katwal S. Evaluating aortomesenteric parameters in a tertiary center of Nepal for superior mesenteric artery syndrome diagnosis and risk factors: cross-sectional study. Ann Med Surg (Lond) 2024; 86:2612-2618. [PMID: 38694377 PMCID: PMC11060225 DOI: 10.1097/ms9.0000000000001962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/04/2024] [Indexed: 05/04/2024] Open
Abstract
Background and objectives This study examines aortomesenteric angle (AMA) and distance (AMD), which are critical in superior mesenteric artery (SMA) syndrome. Addressing the scarcity of SMA cases, the research explores potential links with lower BMI and aims to establish normative data for diagnostic and predictive purposes, using contrast-enhanced computed tomography (CT) scans across various BMI and sex categories. Methodology A retrospective quantitative cross-sectional study was conducted on 189 patients undergoing abdominal contrast-enhanced CT scans between December 2019 and December 2020. Ethical clearance was obtained, and participants provided informed consent. Exclusion criteria targeted specific medical histories. Patient demographics, BMI categories, and imaging data were recorded. Helical 128-slice CT scans were employed, with sagittal-oblique multiplanar reconstructions for parameter assessments. Statistical analysis utilized SPSS 26.0, including Pearson correlation coefficients and mean calculations. Results The study reveals a mean AMA of 54.07°±8.53° and a mean distance of 16.25±3.44 mm. Elevated BMI is found to positively correlate with AMA and distance, indicating that higher BMI values may augment these parameters, with an additional positive correlation observed between AMA and distance. No significant correlations are found with patient age or sex. Conclusion The study concludes that decreased BMI may pose a potential risk for SMA syndrome, as evidenced by the observed correlations with aortomesenteric parameters. Understanding these normal values in the Nepalese population is critical for accurate diagnoses and predictions using CT scans. The research highlights the impact of demographic factors on these parameters and emphasizes their significance in clinical assessments related to SMA syndrome.
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Affiliation(s)
- Diwas Sapkota
- Department of Radiology, National Academy of Medical Sciences, Kathmandu
| | | | - Aimandu Shrestha
- Department of Radiology, National Academy of Medical Sciences, Kathmandu
| | - Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura, Nepal
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Muñoz-Palomeque SA, Tobar-Tinoco A, Torres-Guaicha MV, Tinoco-Ortiz TL. Robotic management of superior mesenteric artery syndrome. J Surg Case Rep 2024; 2024:rjae190. [PMID: 38605691 PMCID: PMC11007637 DOI: 10.1093/jscr/rjae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
Wilkie's syndrome is an unusual cause of upper intestinal obstruction due to mechanical compression of the superior mesenteric artery (SMA) to the duodenum, with nonspecific symptoms, whose diagnosis is confirmed by angiotomography. Initially, the treatment is conservative to regain weight and restore mesenteric adipose tissue, associated with postural changes of the patient. If this fails, surgical treatment is indicated, being laparoscopic duodenojejunostomy described as the gold standard. Robotics' assistance is feasible and safe to carry out the procedure. We present the case of a 21-year-old male patient who comes with stabbing abdominal pain and persistent postprandial vomiting that has caused weight loss of 11 kilograms in the last 2 years without apparent cause, associated with gastroesophageal reflux. During the procedure, we evidenced open diaphragmatic pillars and duodenal compression due to SMA, and robotic-assisted laparoscopic hyatoplasty + Nissen fundoplication + duodenojejunostomy were performed without complications, with excellent post-surgical results.
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Affiliation(s)
- Santiago A Muñoz-Palomeque
- General Surgery Department, Hospital Metropolitano, Quito 170508, Ecuador
- General and Laparoscopic Surgery, Universidad Internacional del Ecuador, Quito 170411, Ecuador
| | - Ariadna Tobar-Tinoco
- Universidad UTE, Avenida Mariscal Sucre s/n y Mariana de Jesús, Quito 170129, Ecuador
| | - Máximo V Torres-Guaicha
- General Surgery Department, Hospital Metropolitano, Quito 170508, Ecuador
- Faculty of Medicine, Universidad Central del Ecuador, Quito 170136, Ecuador
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Khan RA, Khan Z, Shahid ZB, Akhter M, Poombal F. Confluence of Challenges: A Case Report of Superior Mesenteric Artery Syndrome Coexisting With Depressive Illness, Severe Weight Loss, and an Incidental Adnexal Cyst. Cureus 2024; 16:e57073. [PMID: 38681341 PMCID: PMC11052636 DOI: 10.7759/cureus.57073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
In the case of a 24-year-old woman experiencing depressive illness, weight loss, vomiting, and hypoglycemia, initial suspicion of gastroenteritis shifted to reveal compensated metabolic acidosis and electrolyte imbalances. A subsequent CT scan revealed both superior mesenteric artery (SMA) syndrome and an incidental adnexal cyst, leading to treatment involving electrolyte correction and laparoscopic duodenojejunostomy, ultimately facilitating her recovery.
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Affiliation(s)
- Raamish A Khan
- Medicine, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Zainab Khan
- Medicine, Nishtar Medical University, Multan, PAK
| | - Zain B Shahid
- Surgery, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Maryum Akhter
- Medicine, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Fnu Poombal
- Pathology, Nishtar Medical University, Multan, PAK
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Bozzola E, Irrera M, Cirillo F, Zanna V, Petrelli I, Diamanti A, Scire Y, Park J, Marchesi A, Marchili MR, Villani A. Superior Mesenteric Artery Syndrome in Anorexia Nervosa: A Case Report and a Systematic Revision of the Literature. Nutrients 2024; 16:541. [PMID: 38398865 PMCID: PMC10893019 DOI: 10.3390/nu16040541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome (SMAS) is a rare condition caused by the compression of the duodenum, which may occur in the case of fast weight loss. Currently, the relationship between superior mesenteric artery syndrome and anorexia nervosa is still unclear. The aim of this study is to identify the precocious clinical signs and symptoms of SMAS in patients affected by anorexia nervosa so as not to delay the diagnosis. METHODS We present the clinical case of a young female patient with anorexia nervosa complicated by SMAS. We performed a literature review of SMAS in children affected by anorexia nervosa between 1962 and 2023, according to the PRISMA Extension Guide for Scoping Reviews. RESULTS Reviewing the literature, 11 clinical cases were described for the pediatric age. The median age at diagnosis was 17 years (ranging from 13 to 18 years). The diagnosis of SMAS may be challenging as symptoms overlap those of anorexia, but it should be kept in mind mostly in cases of post-prandial abdominal pain, anxiety or depression, nausea, vomiting, and weight loss. CONCLUSION Even specific clinical symptoms may act as flag tags to drive attention to this rare but potentially fatal condition.
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Affiliation(s)
- Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Mariangela Irrera
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Flavia Cirillo
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Valeria Zanna
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Italo Petrelli
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Antonella Diamanti
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, IRCCS, 00100 Rome, Italy
| | - Ylenia Scire
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Jibin Park
- Medicine and Surgery School, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | | | | | - Alberto Villani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
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Hasegawa N, Oka A, Awoniyi M, Yoshida Y, Tobita H, Ishimura N, Ishihara S. Dynamic ultrasonography for optimizing treatment position in superior mesenteric artery syndrome: Two case reports and review of literature. World J Gastroenterol 2024; 30:499-508. [PMID: 38414592 PMCID: PMC10895595 DOI: 10.3748/wjg.v30.i5.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta (SMA-Ao). Although the left lateral recumbent position is considered effective in the treatment of SMA syndrome, individual variations in the optimal patient position have been noted. In this report, we present two elderly cases of SMA syndrome that exhibited rapid recovery due to ultrasonographic dynamic evaluation of the optimal position for each patient. CASE SUMMARY Case 1: A 90-year-old man with nausea and vomiting. Following diagnosis of SMA syndrome by computed tomography (CT), ultrasonography (US) revealed the SMA-Ao distance in the supine position (4 mm), which slightly improved in the lateral position (5.7-7.0 mm) without the passage of duodenal contents. However, in the sitting position, the SMA-Ao distance was increased to 15 mm accompanied by improved content passage. Additionally, US indicated enhanced passage upon abdominal massage on the right side. By day 2, the patient could eat comfortably with the optimal position and massage. Case 2: An 87-year-old woman with vomiting. After the diagnosis of SMA syndrome and aspiration pneumonia by CT, dynamic US confirmed the optimal position (SMA-Ao distance was improved to 7 mm in forward-bent position, whereas it remained at 5 mm in the supine position). By day 7 when her pneumonia recovered, she could eat with the optimal position. CONCLUSION The optimal position for SMA syndrome varies among individuals. Dynamic US appears to be a valuable tool in improving patient outcomes.
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Affiliation(s)
- Nobuaki Hasegawa
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Muyiwa Awoniyi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Hepatology Section, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Yuri Yoshida
- Clinical Laboratory Division, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Hiroshi Tobita
- Division of Hepatology, Shimane University Hospital, Izumo 693-8501, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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El Yousfi Z, Halfi IM, El Houss S, Allali N, El Haddad S, Chat L. Superior Mesenteric Artery Syndrome: A Misdiagnosed Disorder. Glob Pediatr Health 2024; 11:2333794X231221705. [PMID: 38188076 PMCID: PMC10768572 DOI: 10.1177/2333794x231221705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/27/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
The superior mesenteric artery syndrome also known as Wilkie's syndrome or Benign duodenal stasis, is a condition that occurs when the third duodenum is compressed between the superior mesenteric artery anteriorly and the abdominal aorta posteriorly following the disappearance of the perivascular fatty tissue. It can emulate the symptoms of an upper abdominal obstruction. This case involves a 9-year-old female patient experiencing food vomiting that did not improve with medication. Radiological work-up, which included an abdominal X-ray and a CT angiography, led to the diagnosis of extrinsic and incomplete obstruction of the third duodenum by the aorto-mesenteric clamp. Unfortunately, this diagnosis is rarely made. The purpose of this article is to provide a review of the etiology, clinical presentation, and imaging findings of this syndrome.
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Affiliation(s)
| | | | | | - Nazik Allali
- Mother and Child Hospital IBN SINA, Rabat, Morocco
| | | | - Latifa Chat
- Mother and Child Hospital IBN SINA, Rabat, Morocco
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Bajour D, Haddad S, Marina S, Zoukar S, Haddad S, Martini N, Khouri L. Co-occurrence of ectopic pancreas and superior mesenteric artery syndrome in a child: A case report and literature review. SAGE Open Med Case Rep 2023; 12:2050313X231220830. [PMID: 38162423 PMCID: PMC10757443 DOI: 10.1177/2050313x231220830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Ectopic pancreas refers to pancreatic tissue that lacks vascular or anatomical connection with the main body of the pancreas. Superior mesenteric artery syndrome involves the compression of the third part of the duodenum between the aorta and the superior mesenteric artery. We present a case of a 12-year-old female with a 4-year history of recurrent episodes of severe epigastric pain, improved by sitting and leaning forward, and occurred monthly for nearly 48 h. Radiological findings confirmed the diagnosis of superior mesenteric artery syndrome. However, further investigation revealed the presence of ectopic pancreas. Surgical intervention successfully treated both conditions. The patient presented with severe abdominal pain, and although there was a diagnosis of superior mesenteric artery syndrome, the pain was not entirely attributable to this condition, as there was no correlation with food intake, and the degree of obstruction was mild. Further investigations revealed the presence of ectopic pancreas, which provided an explanation for the severity of the pain. This case highlights the need for further research on the potential association between superior mesenteric artery syndrome and ectopic pancreas.
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Affiliation(s)
- Dina Bajour
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Salim Haddad
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Sliman Marina
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Sham Zoukar
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Sultaneh Haddad
- Aleppo University, Faculty of Medicine, Aleppo, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Nafiza Martini
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Lina Khouri
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Departement of Pediatrics at Children’s Hospital, Damascus, Syrian Arab Republic
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10
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Liu Y, Zheng H, Wang X, Wang Z, Zhu Q, Wen C, Tong Y. Ultrasound characteristics of abdominal vascular compression syndromes. Front Cardiovasc Med 2023; 10:1282597. [PMID: 38173818 PMCID: PMC10764025 DOI: 10.3389/fcvm.2023.1282597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
Abdominal vascular compression syndrome (AVCS) is caused by the compression of abdominal blood vessels by adjacent structures or the compression of abdominal organs by neighboring blood vessels. Such compressions can result in a variety of clinical symptoms. They are not commonly seen in ultrasound practices, and their presence may have been underrecognized and underdiagnosed. This article reviews the clinical features, ultrasound characteristics, and diagnostic criteria of four types of AVCS, namely, celiac artery compression syndrome, renal vein compression syndrome, iliac vein compression syndrome, and superior mesenteric artery syndrome to increase awareness of these conditions among ultrasound practitioners. The ultrasound criteria for AVCS are primarily based on studies with small sample sizes, and therefore, it is important to exercise caution if these criteria are used.
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Affiliation(s)
- Yan Liu
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Haining Zheng
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Xiaoqing Wang
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Zi Wang
- Department of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiang Zhu
- Department of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chaoyang Wen
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Yisha Tong
- Department of Vascular Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
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11
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Caterine S, Patil NS, Takrouri H, Issenman RM, Stein NR, Donnellan J, Yikilmaz A. Understanding the diagnosis of superior mesenteric artery syndrome: analysis of the location of duodenal impression on upper gastrointestinal studies. Pediatr Radiol 2023; 53:2633-2641. [PMID: 37837457 PMCID: PMC10697883 DOI: 10.1007/s00247-023-05782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Upper gastrointestinal (GI) contrast studies are frequently requested to aid superior mesenteric artery syndrome diagnosis, a rare entity. Compression of the third duodenal part is expected to be mid-to-left of the midline where the superior mesenteric artery arises from the aorta; however, a duodenal impression to the right of the midline due to normal anatomic impression by the inferior vena cava (IVC) is often encountered and frequently misdiagnosed. OBJECTIVE The purpose of this study was to determine the frequencies of (1) normal right-of-midline duodenal impressions and (2) mid-to-left of midline compressions in upper GI studies in a tertiary pediatric referral center. MATERIALS AND METHODS All upper GI studies performed at our institution over 2 years were retrospectively evaluated to determine whether the duodenum had vertical duodenal impression to the right of the vertebral midline, mid-to-left of the vertebral midline, or no identifiable duodenal impression at all. RESULTS In total, 538 upper GI studies were included in this analysis. A total of 275 male and 247 female patients between 0 and 17 years of age (median: 6 years, range: 1 month-17 years) were included. Of 538 total upper GI studies, there were 240 studies (44.6%) with a right-of-midline impression. There were only 10 studies (1.9%) with a mid-to-left of midline compression, and 9/10 also showed a concurrent right-sided impression sign. CONCLUSION Right-of-midline duodenal impression is a normal anatomic finding caused by the IVC and should not be confused with superior mesenteric artery syndrome. In the presence of an appropriate clinical context, proximal duodenal dilation, "to-and-fro" motion of contrast, and duodenal impression at mid-to-left of midline, a diagnosis of superior mesenteric artery syndrome should be considered.
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Affiliation(s)
- Scott Caterine
- Department of Pediatric Radiology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Nikhil S Patil
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Heba Takrouri
- Department of Pediatric Radiology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Robert M Issenman
- Department of Pediatric Gastroenterology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Nina R Stein
- Department of Pediatric Radiology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - John Donnellan
- Department of Pediatric Radiology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Ali Yikilmaz
- Department of Pediatric Radiology, McMaster Children's Hospital, Hamilton, ON, Canada.
- Diagnostic Imaging, Hamilton Health Sciences, McMaster Children's Hospital, Room 2S28, 1200 Main St. West, Hamilton, ON, L8N 3Z5, Canada.
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Mountjoy M, Ackerman KE, Bailey DM, Burke LM, Constantini N, Hackney AC, Heikura IA, Melin A, Pensgaard AM, Stellingwerff T, Sundgot-Borgen JK, Torstveit MK, Jacobsen AU, Verhagen E, Budgett R, Engebretsen L, Erdener U. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med 2023; 57:1073-1097. [PMID: 37752011 DOI: 10.1136/bjsports-2023-106994] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/28/2023]
Abstract
Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee's expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.
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Affiliation(s)
- Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Games Group, International Olympic Committee, Lausanne, Switzerland
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Naama Constantini
- Sports Medicine Center, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Anthony C Hackney
- Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ida Aliisa Heikura
- Canada Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Anna Melin
- Department of Sport Science - Swedish Olympic Committee Research Fellow, Linnaeus University, Kalmar, Sweden
| | - Anne Marte Pensgaard
- Department of Sport and Social Sciences, Norwegian School of Sports Sciences, Oslo, Norway
| | - Trent Stellingwerff
- Canada Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | | | | | | | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Science, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Uğur Erdener
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
- World Archery, Lausanne, Switzerland
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13
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Ackerman KE, Rogers MA, Heikura IA, Burke LM, Stellingwerff T, Hackney AC, Verhagen E, Schley S, Saville GH, Mountjoy M, Holtzman B. Methodology for studying Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the International Olympic Committee (IOC) consensus on REDs. Br J Sports Med 2023; 57:1136-1147. [PMID: 37752010 DOI: 10.1136/bjsports-2023-107359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/28/2023]
Abstract
In the past decade, the study of relationships among nutrition, exercise and the effects on health and athletic performance, has substantially increased. The 2014 introduction of Relative Energy Deficiency in Sport (REDs) prompted sports scientists and clinicians to investigate these relationships in more populations and with more outcomes than had been previously pursued in mostly white, adolescent or young adult, female athletes. Much of the existing physiology and concepts, however, are either based on or extrapolated from limited studies, and the comparison of studies is hindered by the lack of standardised protocols. In this review, we have evaluated and outlined current best practice methodologies to study REDs in an attempt to guide future research.This includes an agreement on the definition of key terms, a summary of study designs with appropriate applications, descriptions of best practices for blood collection and assessment and a description of methods used to assess specific REDs sequelae, stratified as either Preferred, Used and Recommended or Potential Researchers can use the compiled information herein when planning studies to more consistently select the proper tools to investigate their domain of interest. Thus, the goal of this review is to standardise REDs research methods to strengthen future studies and improve REDs prevention, diagnosis and care.
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Affiliation(s)
- Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margot Anne Rogers
- Australian Institute of Sport, Bruce, South Australia, Australia
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australian Capital Territory, Australia
| | - Ida A Heikura
- Canadian Sport Institute-Pacific, Victoria, British Columbia, Canada
- Department of Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Louise M Burke
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Trent Stellingwerff
- Canadian Sport Institute-Pacific, Victoria, British Columbia, Canada
- Department of Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Anthony C Hackney
- Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports and Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Stacey Schley
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Grace H Saville
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Games Group, International Olympic Committee, Lausanne, Switzerland
| | - Bryan Holtzman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Mass General for Children, Boston, Massachusetts, USA
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14
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Oka A, Awoniyi M, Hasegawa N, Yoshida Y, Tobita H, Ishimura N, Ishihara S. Superior mesenteric artery syndrome: Diagnosis and management. World J Clin Cases 2023; 11:3369-3384. [PMID: 37383896 PMCID: PMC10294176 DOI: 10.12998/wjcc.v11.i15.3369] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/13/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
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. The median age of patients is 23 years old (range 0-91 years old) and predominant in females over males with a ratio of 3:2. The symptoms are variable, consisting of postprandial abdominal pain, nausea and vomiting, early satiety, anorexia, and weight loss and can mimic anorexia nervosa or functional dyspepsia. Because recurrent vomiting leads to aspiration pneumonia or respiratory depression via metabolic alkalosis, early diagnosis is required. The useful diagnostic modalities are computed tomography as a standard tool and ultrasonography, which has advantages in safety and capability of real-time assessments of SMA mobility and duodenum passage. The initial treatment is usually conservative, including postural change, gastroduodenal decompression, and nutrient management (success rates: 70%-80%). If conservative therapy fails, surgical treatment (i.e., laparoscopic duodenojejunostomy) is recommended (success rates: 80%-100%).
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Affiliation(s)
- Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Muyiwa Awoniyi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Hepatology Section, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Nobuaki Hasegawa
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yuri Yoshida
- Clinical Laboratory Division, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Hiroshi Tobita
- Division of Hepatology, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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15
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Xie J, Bai J, Zheng T, Shu J, Liu ML. Causes of epigastric pain and vomiting after laparoscopic-assisted radical right hemicolectomy - superior mesenteric artery syndrome. World J Gastrointest Surg 2023; 15:193-200. [PMID: 36896299 PMCID: PMC9988633 DOI: 10.4240/wjgs.v15.i2.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/19/2022] [Accepted: 01/10/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome (SMAS) is a rare condition causing functional obstruction of the third portion of the duodenum. Postoperative SMAS following laparoscopic-assisted radical right hemicolectomy is even less prevalent and can often be unrecognized by radiologists and clinicians.
AIM To analyze the clinical features, risk factors, and prevention of SMAS after laparoscopic-assisted radical right hemicolectomy.
METHODS We retrospectively analyzed clinical data of 256 patients undergoing laparoscopic-assisted radical right hemicolectomy in the Affiliated Hospital of Southwest Medical University from January 2019 to May 2022. The occurrence of SMAS and its countermeasures were evaluated. Among the 256 patients, SMAS was confirmed in six patients (2.3%) by postoperative clinical presentation and imaging features. All six patients were examined by enhanced computed tomography (CT) before and after surgery. Patients who developed SMAS after surgery were used as the experimental group. A simple random sampling method was used to select 20 patients who underwent surgery at the same time but did not develop SMAS and received preoperative abdominal enhanced CT as the control group. The angle and distance between the superior mesenteric artery and abdominal aorta were measured before and after surgery in the experimental group and before surgery in the control group. The preoperative body mass index (BMI) of the experimental group and the control group was calculated. The type of lymphadenectomy and surgical approach in the experimental and control groups were recorded. The differences in angle and distance were compared preoperatively and postoperatively in the experimental group compared. The differences in angle, distance, BMI, type of lymphadenectomy and surgical approach between the experimental and control groups were compared, and the diagnostic efficacy of the significant parameters was assessed using receiver operating characteristic curves.
RESULTS In the experimental group, the aortomesenteric angle and distance after surgery were significantly decreased than those before surgery (P < 0.05). The aortomesenteric angle, distance and BMI were significantly higher in the control group than in the experimental (P < 0.05). There was no significant difference in the type of lymphadenectomy and surgical approach between the two groups (P > 0.05).
CONCLUSION The small preoperative aortomesenteric angle and distance and low BMI may be important factors for the complication. Over-cleaning of lymph fatty tissues may also be associated with this complication.
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Affiliation(s)
- Juan Xie
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Jiao Bai
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ting Zheng
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ma-Li Liu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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16
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Muacevic A, Adler JR. Superior Mesenteric Artery Syndrome in Down Syndrome: A Case Report. Cureus 2022; 14:e31854. [PMID: 36579270 PMCID: PMC9792329 DOI: 10.7759/cureus.31854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 11/25/2022] Open
Abstract
Down syndrome is a common chromosomal abnormality, which is associated with a wide spectrum of multiorgan complications, including gastrointestinal disorders. Superior mesenteric artery syndrome is a rare type of small intestinal obstruction caused by compression of the duodenum between the superior mesenteric artery anteriorly and the abdominal aorta posteriorly. A 12-year-old boy with Down syndrome came to the emergency department with a first seizure secondary to electrolyte disturbances. He had been having recurrent episodes of bilious vomiting. Computed tomography of the abdomen revealed a markedly distended stomach and proximal duodenum with a narrow aortomesenteric angle consistent with superior mesenteric artery syndrome. The patient received successful conservative treatment with aggressive fluid resuscitation, bowel decompression, and electrolyte correction. Child protection services found that the patient had rapid weight loss recently after parents were confronted with the confirmed diagnosis of Down syndrome in their child. Physicians need to consider superior mesenteric artery syndrome in any child with an intellectual disability presenting with a clinical picture of intestinal obstruction.
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17
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Superior Mesenteric Artery Syndrome Managed with Laparoscopic Duodenojejunostomy. Minim Invasive Surg 2022; 2022:4607440. [PMID: 35965959 PMCID: PMC9365593 DOI: 10.1155/2022/4607440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 05/08/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background Superior mesenteric artery (SMA) syndrome is a rare disorder that may be managed surgically if conservative management fails. Different surgical techniques have been described, division of the ligament of Treitz, gastrojejunostomy, and duodenojejunostomy. The aim of this case series is to show that laparoscopic duodenojejunostomy is a safe and technically feasible management for superior mesenteric artery syndrome. Methods In this case series, we retrospectively identified all patients who underwent laparoscopic duodenojejunostomy for SMA syndrome in our tertiary university center between December 2016 and July 2019. Data collected included demographics, presenting symptoms, comorbidities, pre and postoperative body mass index (BMI), operative approach, operative blood loss, operative duration, clinical and radiological results, in hospital/30-day complications, mortality, and postoperative follow-up outcomes. Results We identified eleven patients, 10 females and 1 male, with a median age 23 years (range 17–43 years). All patients had refractory symptoms after a minimum of two months of conservative management and subsequently underwent laparoscopic duodenojejunostomy. There were no intraoperative complications and no in-hospital or 30-day postoperative mortality or complications were identified. Follow-up data showed complete resolution in 73% of patients (n = 8) and only one patient with no improvement postoperatively. Results also showed a median BMI increase of 2 kg/m2 (range 1–9 kg/m2) at a median follow-up of 16 months (range 4–48 months). Conclusion Laparoscopic duodenojejunostomy is a safe treatment option for SMA syndrome and should be considered when patients do not respond to conservative management.
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18
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Ali M, Farooq O, Fatima M, Farooq H. Superior Mesenteric Artery Syndrome: Delayed Diagnosis of a Rare Clinical Entity With a Common Clinical Presentation. Cureus 2022; 14:e26728. [PMID: 35967155 PMCID: PMC9364062 DOI: 10.7759/cureus.26728] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/30/2022] Open
Abstract
Superior mesenteric artery (SMA) syndrome, also known as Wilkie’s syndrome, is an uncommon disorder that involves a set of symptoms that primarily includes postprandial pain at times associated with intestinal obstruction. Although a rare disease in the general population, SMA syndrome has a high probability of occurrence in patients who are severely malnourished or have certain debilitating conditions leading to a loss of retroperitoneal fat. Here, we present the case of a 16-year-old male with a one-year history of postprandial abdominal pain associated with nausea, multiple episodes of vomiting, and abdominal distension. Amid a delayed diagnosis and multiple hospital visits, the patient’s condition further deteriorated. Thereafter, computed tomography of the abdomen confirmed this rare diagnosis. Because the patient could not be further managed conservatively, laparoscopic duodenojejunostomy was planned and done. This case report highlights the various challenges in diagnosing this disease and highlights the importance of an early diagnosis so that patients can be managed effectively and timely.
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19
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Miyata J, Eshak ES, Yoshioka T, Iso H. Movement of the superior mesenteric artery in patients with superior mesenteric artery syndrome: a case-reference study. Clin Anat 2022; 35:891-898. [PMID: 35417615 DOI: 10.1002/ca.23885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/09/2022]
Abstract
Superior mesenteric artery (SMA) syndrome is related to the reduction of the aortomesenteric angle on detailed imaging studies; i.e., an expert's ultrasonography or angiography. We aimed to test a simpler imaging finding of SMA syndrome. This cross-sectional case-reference study examined whether right movement of the SMA on unenhanced computed tomography (CT) is useful for the diagnosis of SMA syndrome. We reviewed hospital records of patients admitted in 2008-2018. Each case was matched to one non-case patient of the same age and sex. On unenhanced CT scans, we identified the shortest distance between the parallel line that passes through the center of the aorta to the line that bisects the spine and SMA. A negative number of the distance means that the SMA is on the left side of the above-described parallel line. There was a total of 14 cases and 14 non-cases (men, 57.1%) with mean age 78.7 years. Mean body mass index of cases and non-cases were 19.2 and 22.2 kg/m2 , respectively. The more prevalent side of the SMA was the right side. The mean shortest distance was 10.5 mm in cases and 0.7 mm in non-cases (P for independent t-test =0.043). For comparing the observations in SMA cases at several time points, the mean shortest distance at pre-onset was -2.7 mm, with a significant difference from that at onset (P for paired t-test =0.030). Right movement of the SMA diagnosed by unenhanced CT is associated with SMA syndrome.
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Affiliation(s)
- Jun Miyata
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Goto, Nagasaki, Japan.,Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Family Medicine, Medical Center for the Entire Family, Keiju Medical Center, Nanao, Ishikawa, Japan
| | - Ehab Salah Eshak
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Public Health and Community Medicine, Minia University, Minia, Egypt
| | - Tetsuya Yoshioka
- Department of Family Medicine, Medical Center for the Entire Family, Keiju Medical Center, Nanao, Ishikawa, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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20
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Tewari S, Sharma RD, Bangar A, Redkar R. Unusual presentation of superior mesenteric artery syndrome in a child. BMJ Case Rep 2022; 15:e246041. [PMID: 35304355 PMCID: PMC8935179 DOI: 10.1136/bcr-2021-246041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/04/2022] Open
Abstract
Superior mesenteric artery syndrome (SMAS), also known as Wilkie's syndrome, is a rare cause of upper gastrointestinal tract obstruction. We report a case of a 10-year-old girl with persistent abdominal pain for over 3 months, who on extensive investigations was diagnosed with SMAS. She underwent a surgical procedure to bypass the obstructed portion of the intestine for relief of her symptoms.
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Affiliation(s)
- Shruti Tewari
- Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, India
| | - Rahul Deo Sharma
- Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, India
| | - Anant Bangar
- Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, India
| | - Rajeev Redkar
- Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, India
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21
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Apostu RC, Chira L, Colcear D, Lebovici A, Nagy G, Scurtu RR, Drasovean R. Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature. World J Clin Cases 2022; 10:1654-1666. [PMID: 35211606 PMCID: PMC8855252 DOI: 10.12998/wjcc.v10.i5.1654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/05/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome is a disease with a complex diagnosis, and it is associated with complications that make it even harder to identify. Currently, a frequent association with psychiatric disorders has been noted. Despite numerous case reports and case series, the variability of the disease has not allowed the development of protocols regarding diagnosis and management.
CASE SUMMARY A 33-year-old woman presented with abdominal pain, nausea, and bile vomiting over the last 15 mo, associated with a 15-kg weight loss over the last three months. After the onset of the symptoms, the patient was diagnosed with anxiety-depressive disorder and treated appropriately. Standard examinations excluded an organic cause, and the cause of the symptoms was considered psychogenic. The persistence of symptoms, even under treatment, prompted a computer tomography angiography examination of the abdomen and pelvis. The examination identified emergence at a sharp angle of 13.7° of the superior mesenteric artery, with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm. A diagnosis of aortomesenteric clamp was established. Surgical treatment by laparoscopic duodenojejunostomy was performed. Postoperative evolution was marked by a patent anastomosis at 1 mo, with a 10-kg weight gain and improvement of the associated anxiety.
CONCLUSION This case report underlines two major aspects. One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders, with an excellent outcome when proper treatment is administered. The second aspect underlines the key role of a multidisciplinary approach and follow-up.
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Affiliation(s)
- Raluca Cristina Apostu
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400001, Romania
| | - Lucian Chira
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400001, Romania
| | - Doina Colcear
- Department of Psychiatry, Clinical Infectious Disease Hospital, Cluj-Napoca 400000, Romania
| | - Andrei Lebovici
- Department of Radiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
| | - Georgiana Nagy
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400006, Romania
| | - Radu Razvan Scurtu
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400001, Romania
| | - Radu Drasovean
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400001, Romania
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22
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Two cases of superior mesenteric artery syndrome during chemotherapy in patients with lung cancer. Int Cancer Conf J 2022; 11:124-128. [PMID: 35425694 PMCID: PMC8938556 DOI: 10.1007/s13691-022-00534-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/18/2022] [Indexed: 02/04/2023] Open
Abstract
Superior mesenteric artery (SMA) syndrome is a rare disease, characterized by the narrowing of the third portion of the duodenum between the aorta and SMA. The cause of the stenosis is a decrease in retroperitoneal fat between the aorta and SMA. In this report, we present two cases of SMA syndrome that occurred during chemotherapy for lung cancer. The first case was a 61-year-old male treated with nanoparticle albumin-bound-paclitaxel (nab-PTX) for lung adenocarcinoma. On day 23 of the first course of nab-PTX, he was admitted to our hospital due to vomiting and weight loss of 15.6 kg in 10 months. He was diagnosed with SMA syndrome through computed tomography, and drainage was performed using a nasogastric tube. Conservative treatment was successful, and the patient was able to continue therapy with nab-PTX. The second case was a 70-year-old male with epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer. He was admitted to our hospital due to vomiting and dizziness while receiving treatment with pembrolizumab, as well as weight loss of 14.6 kg in 6 months. He was diagnosed with SMA syndrome using computed tomography. Conservative treatment using a nasogastric tube led to improvement, and the patient was able to continue treatment with pembrolizumab after discharge. This is the first report of SMA syndrome in patients with lung cancer undergoing chemotherapy with nab-PTX or pembrolizumab. Late diagnosis and treatment render SMA syndrome a potentially fatal disease. Vomiting and weight loss during chemotherapy are known treatment-related side effects; in patients developing these adverse effects, the presence of SMA syndrome should be suspected and managed appropriately.
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23
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Le D, Stirparo JJ, Magdaleno TF, Paulson CL, Roth KR. Point-of-care ultrasound findings in the diagnosis and management of Superior Mesenteric Artery (SMA) syndrome. Am J Emerg Med 2022; 55:233.e1-233.e4. [DOI: 10.1016/j.ajem.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
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van Rensburg AJ, Ghadiri M. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjab630. [PMID: 35087656 PMCID: PMC8790075 DOI: 10.1093/jscr/rjab630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022] Open
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Superior Mesenteric Artery Syndrome: A Community Hospital Case Series. Case Rep Vasc Med 2021; 2021:4033088. [PMID: 34804626 PMCID: PMC8604599 DOI: 10.1155/2021/4033088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/18/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022] Open
Abstract
Superior mesenteric artery syndrome is an obstruction of the small bowel between the aorta and the superior mesenteric artery. Patients with this disease are initially managed medically and those patients who fail medical treatment require surgery. A retrospective case series of thirteen patients diagnosed with SMAS at Flushing Hospital, Flushing, NY, from 2011 to 2020 was performed. Descriptive statistics were used to summarize the characteristics of the entire cohort, and comparative statistics were used to compare the patients who failed medical treatment and required surgery to those who were successfully managed medically. Nine patients were managed conservatively and four patients required operative intervention. BMI was significantly lower in patients requiring operation compared to those who were successfully managed medically. This retrospective community hospital case series adds to the literature on SMAS and provides evidence of BMI as a potential predictor of requiring surgery in SMAS.
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26
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Kim J, Yang S, Im YC, Park I. Superior mesenteric artery syndrome treated successfully by endoscopy-assisted jejunal feeding tube placement. BMJ Case Rep 2021; 14:14/11/e245104. [PMID: 34785514 PMCID: PMC8596032 DOI: 10.1136/bcr-2021-245104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We report the case of a 31-year-old man with superior mesenteric artery syndrome after reoperation due to postoperative complications from rectal cancer. Although initial total parenteral nutrition (TPN) therapy failed, he underwent endoscopy-assisted feeding tube placement without complications instead of surgery. After 2 weeks of dual feeding (enteral feeding and TPN), he improved, gaining 6 kg; and an oral diet was advanced.
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Affiliation(s)
- Jongkuk Kim
- Department of General Surgery, University of Ulsan College of Medicine and Ulsan University Hospital, Ulsan, Republic of Korea
| | - Songsoo Yang
- Department of General Surgery, University of Ulsan College of Medicine and Ulsan University Hospital, Ulsan, Republic of Korea
| | - Yeong Cheol Im
- Department of General Surgery, University of Ulsan College of Medicine and Ulsan University Hospital, Ulsan, Republic of Korea
| | - Inkyu Park
- Department of General Surgery, University of Ulsan College of Medicine and Ulsan University Hospital, Ulsan, Republic of Korea
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27
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Kim JY, Shin MS, Lee S. Endoscopic features for early decision to evaluate superior mesenteric artery syndrome in children. BMC Pediatr 2021; 21:392. [PMID: 34496824 PMCID: PMC8424886 DOI: 10.1186/s12887-021-02848-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background Diagnostic delay of superior mesenteric artery syndrome (SMAS) is common due to its rarity and lack of index of clinical suspicion. Early diagnosis under suspicion is pivotal for adequate treatment. Present study aims to explore the endoscopic features for early decision to evaluate SMAS in children. Methods In case controlled observation study, the recruitment was limited to patients who had endoscopic finding I or finding 1 plus more as follows: a pulsating vertical or oblique band or slit like luminal narrowing of the third part of the duodenum without no expansion over one third during air insufflation for at least 15 s (finding I), a marked dilation of the duodenal first and second part during air insufflation at the third part of the duodenum (finding II), a bile mixed fluid collection (bile lake) in the stomach (finding III). SMAS was confirmed with UGI series or hypotonic duodenography in enrolled patients. We analyzed positive endoscopic findings related with SMAS. Results The enrolled 29 patients consisted of 18 (62.1%) with SMAS and 11 (37.9%) without SMAS. The three most common presenting symptoms were abdominal pain, postprandial discomfort, and early satiety. The clinical impressions based on history and physical examination before endoscopy were functional dyspepsia (34.6%), gastritis or gastric ulcer (31.0%), and SMAS (17.3%). The constellation of three endoscopic findings (finding I + II + III, feature D) observed in 13 (72.2%) patients of SMAS group and 3 (27.3%) patients of non SMAS group (P = 0.027). Of 16 patients with features D, SMAS was diagnosed in 13 patients (81.2%) and not detected in 3 patients (18.8%) on UGI series or hypotonic duodenography. Conclusions Endoscopic examination to the third part of the duodenum can provide a clue making a decision to evaluate SMAS, which consists of features of three endoscopic findings as follows: a pulsating vertical or oblique band or slit like luminal narrowing of the third part of the duodenum without no expansion over one third during air insufflation for at least 15 s, a marked dilation of the first and second part of the duodenum, and a bile lake in the stomach.
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Affiliation(s)
- Jae Young Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, 11 Samjunga-Ro, Sungsan-Gu, Changwon, 51472, South Korea. .,Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, South Korea.
| | - Myung Seok Shin
- Department of Pediatrics, College of Medicine, The Catholic University, St. Mary's Hospital, Daejeon, South Korea
| | - Sunho Lee
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, 11 Samjunga-Ro, Sungsan-Gu, Changwon, 51472, South Korea
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Srisajjakul S, Prapaisilp P, Bangchokdee S. Imaging features of vascular compression in abdomen: Fantasy, phenomenon, or true syndrome. Indian J Radiol Imaging 2021; 27:216-224. [PMID: 28744083 PMCID: PMC5510320 DOI: 10.4103/ijri.ijri_7_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Vascular structures in the abdomen can compress or be compressed by adjacent structures. Classic imaging findings of vascular compressions, including median arcuate ligament syndrome, superior mesenteric artery syndrome, nutcracker syndrome, portal biliopathy, May-Thurner syndrome, and ureteropelvic junction obstruction will be discussed here. It is important to correlate imaging findings and clinical data to identify asymptomatic vascular compression which requires no treatment, intermittent vascular compression with nonspecific or vague clinical manifestation, and the subset of patients with true syndromes who will benefit from treatment.
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Affiliation(s)
- Sitthipong Srisajjakul
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patcharin Prapaisilp
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Malik R, Chen L, Riera A. POCUS Case Review: Considering Superior Mesenteric Artery Syndrome in the Pediatric Emergency Department. Pediatr Emerg Care 2021; 37:172-174. [PMID: 32541404 DOI: 10.1097/pec.0000000000002153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We report a case of a 16-year-old adolescent girl who presented to the pediatric emergency department for worsening abdominal pain and vomiting and had significant weight loss over the previous 4 months. Point-of-care ultrasound was used to assess for signs of superior mesenteric artery syndrome.
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Affiliation(s)
- Rabia Malik
- From the Department of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT
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A rare instance of Wilkie's syndrome in a young male during the holy month of Ramadan. Int J Surg Case Rep 2021; 80:105652. [PMID: 33631645 PMCID: PMC7907469 DOI: 10.1016/j.ijscr.2021.105652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 12/18/2022] Open
Abstract
This is a case report of a young male diagnosed with Superior Mesenteric Artery syndrome during the period of fasting during Ramadan. The purpose of this report is to support physicians in a way of considering this as a differential when their patient presents similarly because it is not exclusive only to anorexic persons and can occur in a population that is fasting as well. The method of management was conservative and this clarifies that surgery does not necessarily have to be the first line treatment.
Introduction and importance Wilkie’s syndrome[SMA(Superior Mesenteric Artery) syndrome or Cast syndrome]) is a unique and rare presentation which may be included in the differential diagnosis especially when a Gastric outlet obstruction is being investigated and there is a history of an associated element of rapid weight loss. The purpose of presenting this case report is its uniqueness given a history of intermittent fasting rather than the usual eating disorders. Case presentation A crescendo worsening of symptoms of intractable vomiting, inability to eat, upper abdominal gas bloating and post meal abdominal pain since one week in a patient during a period of fasting for the first time had been observed. Clinical discussion After initial resuscitation, an ultrasound abdomen and an abdominal x ray revealed a distended stomach and a nasogastric tube was immediately introduced to avoid aspiration. A CT scan of the abdomen with contrast revealed the compressed duodenum in the aortomesenteric angle and the diagnosis of SMA syndrome was confirmed. An upper gastrointestinal endoscopy was also done to rule out other causes and it was found to be normal. Conclusion In an acute presentation, the response to conservative management is remarkable and in the absence of any possible future reoccurrences the surgical options may be avoided. High index of suspicion, appropriate radiological diagnosis and stepwise treatment options may guide the troubled patient towards recovery in this rare presentation. A proper history taking is key in diagnosing such a condition and does not have to be limited to eating disorders, typically.
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Bronswijk M, Fransen L, Vanella G, Hiele M, van der Merwe S. Successful treatment of superior mesenteric artery syndrome by endoscopic ultrasound-guided gastrojejunostomy. Endoscopy 2021; 53:204-205. [PMID: 32559775 DOI: 10.1055/a-1190-3228] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Lennert Fransen
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Giuseppe Vanella
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Martin Hiele
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Schalk van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
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Cheng CI, Cheng KY, Tsai MJ. Man With Persistent Vomiting. Ann Emerg Med 2021; 77:e68-e69. [PMID: 33349380 DOI: 10.1016/j.annemergmed.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Chia-I Cheng
- Department of Emergency Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Kai-Yuan Cheng
- Department of Emergency Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Ming-Jen Tsai
- Department of Emergency Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.
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Ribeiro FS, Puech-Leão P, Zerati AE, Nahas WC, David-Neto E, De Luccia N. Prevalence of left renal vein compression (nutcracker phenomenon) signs on computed tomography angiography of healthy individuals. J Vasc Surg Venous Lymphat Disord 2020; 8:1058-1065. [DOI: 10.1016/j.jvsv.2020.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/08/2020] [Indexed: 01/18/2023]
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Haider A, Sharma M, Siddiqa A. Superior Mesenteric Artery Syndrome: A Forgotten Cause of Duodenal Obstruction. Cureus 2020; 12:e10710. [PMID: 33133874 PMCID: PMC7595650 DOI: 10.7759/cureus.10710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Superior mesenteric artery (SMA) syndrome has been described in medical literature as a rare cause of duodenal occlusion. It has a varied presentation, with distressing gastrointestinal symptoms such as nausea, abdominal pain, and further weight loss. Several conditions contribute to duodenal obstruction in SMA syndrome. We present a case of SMA syndrome in a patient with malignant breast cancer who presented with sudden onset of severe nausea and voluminous vomiting. Various imaging studies revealed a distended proximal intestine with a transition point in the third part of the duodenum. The patient was managed conservatively with nasogastric decompression and fluid electrolyte management, leading to symptomatic relief.
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Affiliation(s)
- Asim Haider
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Madhav Sharma
- Internal Medicine, BronxCare Health System, Bronx, USA
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Hirai T, Kitada M, Hayashi Y, Monno I, Takagaki Y, Shimada K, Ogura Y, Fujii M, Konishi K, Nakagawa A, Koya D. Case report of superior mesenteric artery syndrome that developed in a lean type 2 diabetes patient and was associated with rapid body weight loss after sodium-glucose cotransporter 2 inhibitor administration. J Diabetes Investig 2020; 11:1359-1362. [PMID: 32020751 PMCID: PMC7477529 DOI: 10.1111/jdi.13228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/21/2020] [Accepted: 02/02/2020] [Indexed: 11/28/2022] Open
Abstract
A 58-year-old women who was diagnosed with type 2 diabetes 20 years earlier had been treated with antidiabetic medicines since she was aged 40 years. After sodium-glucose cotransporter 2 inhibitors administration, her bodyweight rapidly decreased from 40 to 30 kg over a period of 3 weeks. She had abdominal symptoms, including nausea, especially after a meal. On admission, physical examinations and laboratory data showed euglycemic ketoacidosis, dehydration and low insulin secretion levels. Additionally, abdominal contrast computed tomography showed the finding of superior mesenteric artery syndrome. This case urges caution, including rapid excessive bodyweight loss and euglycemic ketoacidosis, on the use of sodium-glucose cotransporter 2 for lean diabetes patients.
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Affiliation(s)
- Taro Hirai
- Department of Diabetology and EndocrinologyKanazawa Medical UniversityUchinadaJapan
| | - Munehiro Kitada
- Department of Diabetology and EndocrinologyKanazawa Medical UniversityUchinadaJapan
| | - Yoshihiro Hayashi
- Department of Diabetology and EndocrinologyKanazawa Medical UniversityUchinadaJapan
| | - Itaru Monno
- Department of Diabetology and EndocrinologyKanazawa Medical UniversityUchinadaJapan
| | - Yuta Takagaki
- Department of Diabetology and EndocrinologyKanazawa Medical UniversityUchinadaJapan
| | - Keiji Shimada
- Department of Diabetology and EndocrinologyKanazawa Medical UniversityUchinadaJapan
| | - Yoshio Ogura
- Department of Diabetology and EndocrinologyKanazawa Medical UniversityUchinadaJapan
| | - Mizue Fujii
- Department of Diabetology and EndocrinologyKanazawa Medical UniversityUchinadaJapan
| | - Kazunori Konishi
- Department of Diabetology and EndocrinologyKanazawa Medical UniversityUchinadaJapan
| | - Atsushi Nakagawa
- Department of Diabetology and EndocrinologyKanazawa Medical UniversityUchinadaJapan
| | - Daisuke Koya
- Department of Diabetology and EndocrinologyKanazawa Medical UniversityUchinadaJapan
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Tharu S, Tharu B, Mahgoub M, Khalid MU, Ahmed A. Superior Mesenteric Artery Syndrome: A Classic Presentation of a Rare Entity. Cureus 2020; 12:e9990. [PMID: 32983690 PMCID: PMC7511069 DOI: 10.7759/cureus.9990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 32-year-old female with a past medical history of constipation (predominant irritable bowel syndrome (IBS) and gastro-esophageal reflux disease (GERD)) presented with a complaint of pain in the lower abdomen. She lost 20 pounds in three months with a current body mass index (BMI) of 19.5 kg/m2 (ref: normal level 18.5-24.9). Computed tomography (CT) of the abdomen with contrast showed very little intra-abdominal fat, enlarged proximal duodenum, and decreased aorto-mesenteric angle of 15.40 suggestive of superior mesenteric artery (SMA) syndrome. Per general surgery, the patient was managed conservatively: initially Nil Per Os (NPO), slowly transitioned to a clear liquid diet, soft diet, and solid diet. She tolerated the diet, improved clinically, and was discharged home.
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Affiliation(s)
- Sunraj Tharu
- Audiology and Speech Language Pathology, Institute of Medicine (IOM), Kathmandu, NPL
| | - Biswaraj Tharu
- Internal Medicine, Western Reserve Health Education/Northeast Ohio Medical University (NEOMED), Warren, USA
| | - Mohammed Mahgoub
- Medicine, Western Reserve Health Education/Northeast Ohio Medical University (NEOMED), Warren, USA
| | | | - Arooj Ahmed
- Medicine, Western Reserve Health Education/Northeast Ohio Medical University (NEOMED), Warren, USA
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Alzerwi NAN. Predictors of Superior Mesenteric Artery Syndrome: Evidence from a Case-Control Study. Cureus 2020; 12:e9715. [PMID: 32821627 PMCID: PMC7429617 DOI: 10.7759/cureus.9715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/13/2020] [Indexed: 01/24/2023] Open
Abstract
Introduction Superior mesenteric artery (SMA) or Wilkie's syndrome is a rare condition arising due to compression of the third part of the duodenum between the abdominal aorta and the superior mesenteric artery. It is important to explore factors which help in suspicion and early diagnosis of the condition. The aim of this study was to find out if measurements of aortomesenteric angle and distance can predict the occurrence of SMA syndrome. Another objective was to find out if the BMI was correlated with the aortomesenteric angle and distance of the patients. Methods A retrospective hospital-based case-control study was conducted in Qimat Rai Gupta Central hospital, Haryana, India from 2018-2020. Out of total 2100 records of acute and chronic abdominal pain patients, only seven cases of Wilkie's syndrome were confirmed via Contrast-Enhanced Computed Tomography (CECT). Information on age, gender, BMI, duration of symptoms, clinical presentation, aortomesenteric angle, and distance was compared among three groups: Group I-SMA syndrome patients (N=7), Group II- acute abdominal pain patients (N=14) and Group III- chronic abdominal pain patients (N=14). Results The hospital prevalence of Wilkie's was found to be 0.3%. The median age of patients in Group I corresponded to 26 years as opposed to Group II (31.5years) and Group III (30.5 years). There was a statistically significant reduction in the aortomesenteric angle and distance of Group I patients (22º, 6mm) as compared to both Group II (52.5º, 11mm) and Group III patients (52º, 11mm). A moderate correlation of BMI was found with aortomesenteric angle (r=0.479) and distance (r=0.357). Conclusions There was a significant reduction in the aortomesenteric angle and distance of the SMA patients as compared to both patients having acute and chronic abdominal pain. The BMI of patients was positively correlated to aortomesenteric angle and distance to the moderate level. Thus BMI along with aortomesenteric angle and distance can predict the presence of SMA syndrome.
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Jin JY, Hwang SM, Kim JW, Cho KY. Eosinophilic gastroenteritis in a child with gastric outlet obstruction mimicking superior mesenteric artery syndrome. ALLERGY ASTHMA & RESPIRATORY DISEASE 2020. [DOI: 10.4168/aard.2020.8.4.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ju Youn Jin
- Department of Pediatrics, Hallym University College of Medicine, Seoul, Korea
| | - Sook Min Hwang
- Department of Radiology, Hallym University College of Medicine, Seoul, Korea
| | - Jeong Won Kim
- Department of Pathology, Hallym University College of Medicine, Seoul, Korea
| | - Ky Young Cho
- Department of Pediatrics, Hallym University College of Medicine, Seoul, Korea
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Food fear, quick satiety and vomiting in a 16 years old girl: It's bulimia, or maybe not…? A case report of Wilkie's syndrome (superior mesenteric artery syndrome). Int J Surg Case Rep 2019; 65:184-188. [PMID: 31726254 PMCID: PMC6854068 DOI: 10.1016/j.ijscr.2019.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 11/22/2022] Open
Abstract
Wilkie’s syndrome (WS) is a rare but impairing condition. WS is defined by an aorto-mesenteric artery angle <25° or an aorto-mesenteric distance of <8 mm. Conservative approaches aim at restoring the correct aorto-mesenteric artery angle. Surgical approaches aim at bypassing the functional duodenal obstruction. The overall WS outcome is good in 80–90% of cases.
Introduction Wilkie’s syndrome (WS), also known as superior mesenteric artery syndrome, is a rare clinical entity caused by compression of the horizontal (third) part of the duodenum between the superior mesenteric artery and the abdominal aorta leading to duodenal obstruction. Presentation of case We report a case of a 16 years girl with long-term history of spontaneous vomiting and self-induced vomiting, also suffering from recurrent retrosternal pain, weight loss and thus reduced quality of life. Contrast intestinal series showed a large axial hernia which was laparoscopically reduced and treated by hiatoplasty and anterior hemifundoplication. After initial relief, recurrent postprandial nausea and vomiting reoccurred 4 weeks postoperatively. Abdominal MRI study revealed findings compatible with WS. After endoscopic exclusion of an anatomical duodenal lumen stenosis, she was successfully treated by duodeno-jejunostomy with a favorable outcome. Discussion WS might be hidden behind presumably more evident diagnoses such as bulimia, significant axial hernia and gastro-esophageal reflux disease in patients with recurred vomiting, abdominal pain and weight loss. Conclusion The rare clinical entity of a WS necessitates a targeted diagnostic evaluation and therapy. Clinical details, diagnostic studies and treatment are discussed here.
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Abstract
PURPOSE To provide a review of the etiology, clinical presentation, and imaging findings of superior mesenteric artery (SMA) syndrome. METHODS A literature review of 24 relevant articles regarding SMA syndrome was performed. RESULTS Clinicians and radiologists with a high index of suspicion based on symptomatology may pursue radiologic investigation in the form of upper gastrointestinal (GI) series and contrast-enhanced abdominal computed tomography (CT). Magnetic resonance imaging (MRI) and ultrasound (US) are less commonly utilized modalities in the work-up of SMA syndrome, but provide imaging alternatives without the use of ionizing radiation. Imaging can assist in diagnosis by demonstrating characteristic findings of reduced aortomesenteric angle, reduced aortomesenteric distance, gastroduodenal distention, bowel caliber narrowing at the takeoff of the superior mesenteric artery from the aorta, as well as delayed gastric emptying or positional obstruction observed with real time with fluoroscopy. CONCLUSION SMA syndrome is a rare disease that can go unrecognized and undiagnosed, exacerbating weight loss in an already significantly malnourished patient population. The diagnosis of SMA syndrome must be based on clinical symptomatology correlated with radiographic information. Once diagnosed, SMA syndrome can be safely treated by conservative measures although occasionally requires invasive intervention in the form of enteral tube placement, percutaneous jejunostomy tube placement, total parenteral nutrition, ligament of Treitz lysis, or duodenojejunostomy.
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Superior mesenteric artery syndrome after severe head trauma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ahmad KS, Alenazi NA, Essa MS, Alrushdan MS, Al-Shoaib AM. Laparoscopic Duodenojejunostomy for Superior Mesenteric Vein Syndrome Associated with Nutcracker Phenomenon: The First Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1108-1113. [PMID: 31350383 PMCID: PMC6683307 DOI: 10.12659/ajcr.917172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Patient: Male, 33 Final Diagnosis: Superior mesenteric vein syndrome Symptoms: Epigastric pain Medication: — Clinical Procedure: Laparoscopic duodenojejunostomy Specialty: Surgery
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Affiliation(s)
- Khaled S Ahmad
- Department of General Surgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Naif A Alenazi
- Department of General Surgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Mohamed S Essa
- Department of General Surgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Mahir S Alrushdan
- Department of General Surgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
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Okazaki Y, Higashi Y, Takigawa H. Unusual Complication of Frailty: Superior Mesenteric Artery Syndrome. Intern Med 2019; 58:2119-2120. [PMID: 30918196 PMCID: PMC6701997 DOI: 10.2169/internalmedicine.2493-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yuji Okazaki
- Department of Internal Medicine, Akiota Hospital, Japan
| | | | - Hidehiko Takigawa
- Department of Gastroenterology and Metabolism, Hiroshima University, Japan
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Cappell MS, Gjeorgjievski M, Orosey M. Case Report of Novel Endoscopic Findings in SMA Syndrome Demonstrated by Video Endoscopy: Visibly Pulsating, Band-Like, Compression in Third Portion of Duodenum, with the Pulsations Corresponding One-for-One with the Radial Pulse and EKG Cycle. Dig Dis Sci 2019; 64:1715-1718. [PMID: 30725288 DOI: 10.1007/s10620-019-5472-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/16/2019] [Indexed: 12/09/2022]
Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, MOB 602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA. .,Division of Gastroenterology and Hepatology, Department of Medicine, Oakland University William Beaumont School of Medicine, MOB 602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA.
| | - Mihajlo Gjeorgjievski
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, MOB 602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA
| | - Molly Orosey
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, MOB 602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA
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Gastric Emphysema in a Critically Ill Patient Successfully Treated without Surgery. Case Rep Crit Care 2019; 2019:1824101. [PMID: 31011454 PMCID: PMC6442441 DOI: 10.1155/2019/1824101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/14/2019] [Indexed: 11/18/2022] Open
Abstract
Gastric emphysema is a relatively rare clinical entity caused by injury to the gastric mucosa. A 62-year-old Japanese male with a history of heavy alcohol consumption and smoking was admitted to the emergency intensive care unit due to severe hypercapnic respiratory acidosis. His body mass index was only 12.6. Ten days after initiation of enteral feeding, he complained of abdominal pain. Computed tomography revealed intraluminal air in the distended gastric wall. Esophagogastroduodenoscopy showed diffuse edema, redness, and erosion throughout the stomach. Based on the findings of narrow angle and short distance of the aorta-superior mesenteric artery, the patient was diagnosed with gastric emphysema associated with superior mesenteric artery syndrome. He was successfully managed nonoperatively with treatments including intravenous antibiotics, gastric decompression, and bowel rest. Physicians should be aware of this unusual condition in such critically ill patients complaining of abdominal pain and needing close monitoring and observation to exclude gastric necrosis or perforation.
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Chrysikos D, Troupis T, Tsiaoussis J, Sgantzos M, Bonatsos V, Karampelias V, Piperos T, Kalles V, Theodoropoulos P, Kakaviatos D, Flessas I, Nikou E, Mariolis-Sapsakos T. Superior mesenteric artery syndrome: a rare case of upper gastrointestinal obstruction. J Surg Case Rep 2019; 2019:rjz054. [PMID: 30886692 PMCID: PMC6413377 DOI: 10.1093/jscr/rjz054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/17/2019] [Accepted: 02/12/2019] [Indexed: 12/26/2022] Open
Abstract
Superior mesenteric artery (SMA) or Wilkie’s syndrome is a rare clinical entity of partial or complete duodenal obstruction. The pathogenic mechanism is an acute angulation of the SMA which leads to compression of the third part of the duodenum between the SMA and the aorta. This is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. Its treatment is initially conservative and in case of failure, surgical therapy is unavoidable. We present a case of a 68-year-old female patient who presented in our Department with symptoms of dehydration after persistent vomiting for months. After complete radiologic workup, SMA syndrome was diagnosed and was successfully treated operatively. SMA syndrome might be a diagnostic challenge and must be always included in the differential diagnosis of upper gastrointestinal obstruction. Consequently, this paper aims to increase the awareness of a rare entity of duodenal obstruction.
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Affiliation(s)
- Dimosthenis Chrysikos
- University Department of Surgery, General and Oncologic Hospital of Kifissia 'Agii Anargiri', Athens, Greece
| | - Theodore Troupis
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John Tsiaoussis
- Department of Anatomy, School of Medicine, University of Crete, Crete, Greece
| | - Markos Sgantzos
- Department of Anatomy, Medical School, University of Thessaly, Larissa, Greece
| | - Vasileios Bonatsos
- University Department of Surgery, General and Oncologic Hospital of Kifissia 'Agii Anargiri', Athens, Greece
| | - Vasileios Karampelias
- University Department of Surgery, General and Oncologic Hospital of Kifissia 'Agii Anargiri', Athens, Greece
| | - Theodoros Piperos
- University Department of Surgery, General and Oncologic Hospital of Kifissia 'Agii Anargiri', Athens, Greece
| | - Vasileios Kalles
- University Department of Surgery, General and Oncologic Hospital of Kifissia 'Agii Anargiri', Athens, Greece
| | - Panagiotis Theodoropoulos
- University Department of Surgery, General and Oncologic Hospital of Kifissia 'Agii Anargiri', Athens, Greece
| | - Dimosthenis Kakaviatos
- University Department of Surgery, General and Oncologic Hospital of Kifissia 'Agii Anargiri', Athens, Greece
| | - Ioannis Flessas
- University Department of Surgery, General and Oncologic Hospital of Kifissia 'Agii Anargiri', Athens, Greece
| | - Euthumios Nikou
- University Department of Surgery, General and Oncologic Hospital of Kifissia 'Agii Anargiri', Athens, Greece
| | - Theodoros Mariolis-Sapsakos
- University Department of Surgery, General and Oncologic Hospital of Kifissia 'Agii Anargiri', Athens, Greece
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Shi Y, Shi G, Li Z, Chen Y, Tang S, Huang W. Superior mesenteric artery syndrome coexists with Nutcracker syndrome in a female: a case report. BMC Gastroenterol 2019; 19:15. [PMID: 30674275 PMCID: PMC6343343 DOI: 10.1186/s12876-019-0932-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 01/14/2019] [Indexed: 12/25/2022] Open
Abstract
Background Superior mesenteric artery (SMA) syndrome, also known as Wilkie’s syndrome or Benign duodenal stasis, is a rare benign disease. It could threaten the life if the manifestation is severe and the treatment is inappropriate. 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 stasis and gastrointestinal obstruction. SMA syndrome may rarely combine with Nutcracker syndrome when left renal vein (LRV) was compressed between SMA and AA. Case presentation A 32-year-old female patient presented with complaints of gradually severe bloating, epigastric pain, left flank ache, nausea and occasional vomiting of 1 month’s duration. The epigastric and left flank ache was aggravated when the patient was supine and relieved in a prone or left lateral decubitus. The abdominal bloating was associated with early satiety. The vomiting always started 40 min after meal. The patient gave a history of urine stone with drotaverine hydrochloride tablets treatment for two weeks before the gastrointestinal symptoms arising. The patient had no significant surgical history, but had a rapid weight loss of approximately 10 kg with a body mass index (BMI) from 21 kg/m2 to less than 18 kg/m2 over the last two months. An abdominal examination revealed upper abdominal tenderness and distention. The urine routine examination showed no significant abnormality. The findings of initial blood tests and other laboratory investigations were unremarkable. Conclusions This case reports a female patient with SMA syndrome with Nutcracker syndrome predisposed by Antispasmodics. We highlight the importance of the combination therapy of long-term nutritional supporting and prokinetic agents. Rehabilitating practice after discharge is beneficial to reduce recurrence.
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Affiliation(s)
- Ying Shi
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China. .,The First Clinical Medical College, Jinan University, Guangzhou, 510630, People's Republic of China.
| | - Guangya Shi
- Department of Gastroenterology, The People's Hospital of Fujian Province, 350004, Fujian, People's Republic of China
| | - Zhenyu Li
- Department of Radiology, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China
| | - Yanfang Chen
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China.,The First Clinical Medical College, Jinan University, Guangzhou, 510630, People's Republic of China
| | - Shaohui Tang
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China.,The First Clinical Medical College, Jinan University, Guangzhou, 510630, People's Republic of China
| | - Wei Huang
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China. .,The First Clinical Medical College, Jinan University, Guangzhou, 510630, People's Republic of China.
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Pseudo-obstruction intestinale chronique de l’adulte. Rev Med Interne 2018; 39:792-799. [DOI: 10.1016/j.revmed.2018.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/06/2018] [Accepted: 03/03/2018] [Indexed: 12/17/2022]
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Feng YM, Wan D, Guo R. Case report of gastric distension due to superior mesenteric artery syndrome mimicking hollow viscus perforation: Considerations in critical care ultrasound. Medicine (Baltimore) 2018; 97:e10757. [PMID: 29768359 PMCID: PMC5976289 DOI: 10.1097/md.0000000000010757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Critical care ultrasound identifies the signs of free intraperitoneal air and echogenic free fluid always indicates hollow viscus perforation (HVP) and needs immediate surgical interventions. However, in rare cases, these classic signs may also mislead proper clinical decisions. We report perforated viscus associated large peritoneal effusion with initial critical care ultrasound findings, whereas computed tomography (CT) examination confirmed a giant stomach due to superior mesenteric artery syndrome (SMAS). PATIENT CONCERNS A 70-year-old man was admitted to our emergency department with a complaint of recurrent vomiting with coffee ground emesis for 15 hours and worsen with hypotension for 6 hours. During gastric tube placement, the sudden cardiac arrest occurred. With 22 minutes resuscitation, sinus rhythm was restored. DIAGNOSES Quick ultrasound screen showed large echogenic fluid distributed in the whole abdomen. Diagnostic paracentesis collected "unclotted blood" and combined with a past history of duodenal ulcer, HVP was highly suspected. However, surgical intervention was not performed immediately as unstable vital signs and unfavorable coma states. After adequate resuscitation in intensive care unit, the patient was transferred to perform enhanced CT. Surprisingly, there was no evidence of HVP. Instead, CT showed a giant stomach possibly explained by SMAS. INTERVENTIONS Continuous gastric decompression was performed and 3100 mL coffee ground content was drainage within 24 hours of admission. OUTCOMES Abdominal distension was significantly relieved with improved vital signs. However, as the poor neurological outcome, family members abandon further treatment, and the patient died. LESSONS SMAS is a rare disorder, characterized by small bowel obstruction and severe gastric distension. Nasogastric tube insertion should be aware to protect airway against aspiration. Caution should be utilized to avoid over interpretation of ultrasonography findings on this condition.
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Affiliation(s)
- Yan-Mei Feng
- Department of Respiratory and Critical Care Medicine
| | - Dong Wan
- Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Guo
- Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Kawanishi K, Shojima K, Nishimoto M, Abe H, Kakimoto T, Yasuda Y, Hara T, Kato J. Superior Mesenteric Artery Syndrome May Be Overlooked in Women with Functional Dyspepsia. Intern Med 2017; 56:2549-2554. [PMID: 28883239 PMCID: PMC5658518 DOI: 10.2169/internalmedicine.8647-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective Superior mesenteric artery (SMA) syndrome is characterized by the compression of the third segment of the duodenum between the SMA and aorta, resulting in duodenal obstruction. Because the symptoms of the syndrome are similar to those of functional dyspepsia (FD), this study aimed to examine whether or not patients with SMA syndrome were present among those diagnosed with FD. Methods Patients with an FD diagnosis underwent measurement of the angle and distance between the SMA and aorta by ultrasonography or computed tomography. Patients with an angle of ≤22° or with a distance of ≤8 mm between the SMA and aorta were diagnosed with SMA syndrome. Bacterial culture of the duodenal aspirate was also performed. Results Of the 46 FD patients, 5 (11%) met the criteria. All 5 were women with a body mass index significantly lower than the remaining 41 patients (18.7 vs. 24.0 kg/m2, p=0.003). In addition, all 5 patients had 105/mL or more bacteria in the duodenum. The symptoms of these five patients were treated through dietary and postprandial posture counselling with or without medication. Conclusion Patients with SMA syndrome were observed among underweight women diagnosed with FD. Their symptoms may be associated with bacterial overgrowth.
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Affiliation(s)
- Koki Kawanishi
- Department of Gastroenterology, Wakayama Rosai Hospital, Japan
| | - Kensaku Shojima
- Department of General Internal Medicine, Hashimoto Municipal Hospital, Japan
| | | | - Hiroko Abe
- Department of Gastroenterology, Wakayama Rosai Hospital, Japan
| | | | - Yuko Yasuda
- Department of Gastroenterology, Wakayama Rosai Hospital, Japan
| | - Takeshi Hara
- Department of Gastroenterology, Wakayama Rosai Hospital, Japan
| | - Jun Kato
- Second Department of Internal Medicine, Wakayama Medical University, Japan
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