1
|
Joyeux MA, Pierre A, Barrois M, Hoeffel C, Devie A, Brugel M, Bertin E. Stomach size in anorexia nervosa: A new challenge? EUROPEAN EATING DISORDERS REVIEW 2024; 32:784-794. [PMID: 38520705 DOI: 10.1002/erv.3089] [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: 11/18/2023] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND & AIMS Changes in stomach size may impact eating behaviour. A recent study showed gastric dilatation in restrictive eating disorders using computed tomography scans. This study aimed to describe stomach size in the standing position in women with anorexia nervosa (AN). METHODS Women treated for AN at our institution were retrospectively included if they had undergone upper gastrointestinal radiography (UGR) after the diagnosis of AN. Two control groups (CG1 and CG2) were included, both comprising female patients: CG1 patients were not obese and underwent UGR for digestive symptoms of other aetiologies, and CG2 comprised obese individuals who had UGR before bariatric surgery. A UGR-based Stomach Size Index (SSI), calculated as the ratio of the length of the stomach to the distance between the upper end of the stomach and the top of the iliac crests, was measured in all three groups. Gastromegaly was defined as SSI >1.00. RESULTS 45 patients suffering from AN (28 with restrictive and 17 with binge/purge subtype), 10 CG1 and 20 CG2 subjects were included in this study. Stomach Size Index was significantly higher in AN (1.27 ± 0.24) than in CG1 (0.80 ± 0.11) and CG2 (0.68 ± 0.09); p < 0.001, but was not significantly different between patients with the restrictive and binge/purge subtypes. Gastromegaly was present in 82.2% of patients with AN and not present in the control groups. In patients with AN, gastromegaly was present in 12/15 patients without digestive symptoms (80.0%) and in 25/30 patients with digestive complaints (83.3%) at time of UGR (p = 0.99). In the AN group, no significant relationship was found between SSI and body mass index. CONCLUSION Gastromegaly is frequent in AN and could influence AN recovery. This anatomical modification could partially explain the alterations of gastric motility previously reported in AN.
Collapse
Affiliation(s)
- Marie-Alix Joyeux
- Department of Diabetes, Endocrinology and Nutrition, Robert-Debré Hospital, Reims, France
| | - Antoine Pierre
- Department of Diabetes, Endocrinology and Nutrition, Robert-Debré Hospital, Reims, France
| | - Marion Barrois
- Department of Diabetes, Endocrinology and Nutrition, Robert-Debré Hospital, Reims, France
| | - Christine Hoeffel
- Department of Radiology, Robert-Debré Hospital and Reims-Champagne-Ardenne University, Reims, France
- Reims-Champagne-Ardenne University, Reims, France
| | - Antoine Devie
- Department of Radiology, Robert-Debré Hospital and Reims-Champagne-Ardenne University, Reims, France
| | - Mathias Brugel
- Reims-Champagne-Ardenne University, Reims, France
- Gastroenterology and Digestive Oncology Department, Centre Hospitalier Côte Basque, Bayonne, France
| | - Eric Bertin
- Department of Diabetes, Endocrinology and Nutrition, Robert-Debré Hospital, Reims, France
- Reims-Champagne-Ardenne University, Reims, France
| |
Collapse
|
2
|
Sarikaya S, Altas O, Ozgur MM, Hancer H, Ozdere BA, Ozer T, Aksut M, Rabus MB, Topcu KO, Bas T, Kirali K. Outcomes of conservative management in patients with nutcracker syndrome. Phlebology 2024; 39:403-413. [PMID: 38452734 DOI: 10.1177/02683555241238772] [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] [Indexed: 03/09/2024]
Abstract
OBJECTIVE This study aims to evaluate outcomes in nutcracker syndrome patients with tolerable symptoms and treated conservatively without invasive interventions. METHODS This prospective study included patients treated conservatively. Promoting weight gain, the endpoint of the study was spontaneous resolution of symptoms. RESULTS Sixteen patients (75% female and mean age 24.4 ± 3.5 years) underwent conservative management. Over a mean follow-up of 27.3 months [13-42, interquartile range (IQR)], the diameter ratio (5.5 [5-6.5, IQR] vs 4.3 [4.1-6], p = NS), the peak velocity ratio (6 [5-7, IQR] vs 4.8 [4.8-5.8], p = NS), beak angle (27° [24-30, IQR] vs 29° [24-32]; p = NS), and aortomesenteric angle (26° [23-29, IQR] vs 28° [24-30]; p = NS) exhibited no statistically significant changes. Complete resolution and improvement of symptoms were 28.5% and 31.4%, respectively, while 68.5% remained unchanged. CONCLUSIONS This study shows that a conservative approach contributes to the spontaneous improvement or complete resolution in young adult patients with mild symptoms.
Collapse
Affiliation(s)
- Sabit Sarikaya
- Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ozge Altas
- Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Mert Ozgur
- Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Hakan Hancer
- Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Betul Ayca Ozdere
- Department of radiology department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Tanil Ozer
- Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Aksut
- Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Murat Bulent Rabus
- Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Kamile Ozeren Topcu
- Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Tolga Bas
- Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Kaan Kirali
- Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
3
|
Parr KM, Damjanovic IG, Bale LSW, Damjanovic MM. A case of significant loss of mesenteric fat: Educational and clinical relevance. Morphologie 2024; 108:100771. [PMID: 38458142 DOI: 10.1016/j.morpho.2024.100771] [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: 02/03/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/10/2024]
Abstract
Mesenteric fat, a type of intraperitoneal adipose tissue, plays a critical role in protection and the immune response. Loss of mesenteric fat is a known consequence of a variety of clinical conditions; however, visual documentation of this rare occurrence is not available in the literature searched. Here we report a case of significant loss of mesenteric fat identified during educational dissection of a 79-year-old male fresh frozen donor cadaver, causing the mesenteric folds to appear transparent. The gross anatomical characteristics, clinical importance, and educational significance of this abnormality are described in this report. Knowledge of this condition may be of interest to clinicians, and documentation could benefit anatomists and educators dissecting and teaching in the laboratory setting.
Collapse
Affiliation(s)
- K M Parr
- Queen's University, Department of Biomedical and Molecular Sciences, 18 Stuart Street, Kingston, K7L 3N6 Ontario, Canada
| | - I G Damjanovic
- Queen's University, Department of Biomedical and Molecular Sciences, 18 Stuart Street, Kingston, K7L 3N6 Ontario, Canada
| | - L S W Bale
- Queen's University, Department of Biomedical and Molecular Sciences, 18 Stuart Street, Kingston, K7L 3N6 Ontario, Canada
| | - Madeline M Damjanovic
- Queen's University, Department of Biomedical and Molecular Sciences, 18 Stuart Street, Kingston, K7L 3N6 Ontario, Canada.
| |
Collapse
|
4
|
Navandhar PS, Shinde RK, Gharde P, Nagtode T, Badwaik N. Understanding Superior Mesenteric Artery Syndrome: Etiology, Symptoms, Diagnosis, and Management. Cureus 2024; 16:e61532. [PMID: 38957238 PMCID: PMC11218894 DOI: 10.7759/cureus.61532] [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: 05/03/2024] [Accepted: 06/02/2024] [Indexed: 07/04/2024] Open
Abstract
Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, poses a diagnostic challenge due to its rarity and varied clinical manifestations. This review explores the syndrome's etiology, symptoms, diagnostic challenges, and management strategies. Symptoms range from early satiety to severe abdominal pain, often leading to malnutrition. Diagnosis involves a thorough gastrointestinal evaluation and various imaging modalities. Management includes medical interventions like nasogastric decompression and nutritional support, along with surgical interventions such as duodenojejunostomy. A thorough understanding of SMA syndrome's complexities is crucial for its timely diagnosis and effective management, especially considering its potential overlap with other gastrointestinal disorders or eating disorders. Further research is needed to enhance understanding and improve patient outcomes.
Collapse
Affiliation(s)
- Pratik S Navandhar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Gharde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tushar Nagtode
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitesh Badwaik
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
5
|
Gharti SB, Shrestha N, Thapa KS, Shah R, Khanal P, Shah RK, Gharti SB, Tiwari U. Superior Mesenteric Artery Syndrome in an 11-Year-Old Boy: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241257036. [PMID: 38800090 PMCID: PMC11119349 DOI: 10.1177/11795476241257036] [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: 08/30/2023] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
Superior Mesenteric Artery Syndrome (SMAS) is a rare but potentially life-threatening condition caused by the compression of the duodenum by the superior mesenteric artery. We report a case of an 11-year-old male who complaint of abdominal pain and intermittent vomiting for last 3 weeks. Diagnosis of SMAS was made with the help of radiological findings. The patient was managed conservatively with nutritional support, prokinetic agents, and stomach decompression. After 2 weeks of treatment, the patient's symptoms improved, and he was discharged from the hospital.
Collapse
Affiliation(s)
| | | | | | - Rajat Shah
- Birat Medical College Teaching Hospital, Biratnagar, Nepal
| | - Priti Khanal
- Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| | | | - Sanjeeb Babu Gharti
- Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal
| | | |
Collapse
|
6
|
Talboom A, Van Dessel E. Single Anastomosis Sleeve Jejunal Bypass in Acute Mesenteric Artery Syndrome: A Case Report. Cureus 2024; 16:e60971. [PMID: 38910630 PMCID: PMC11193876 DOI: 10.7759/cureus.60971] [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: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
Superior mesenteric artery syndrome is a rare vascular compression syndrome in which the duodenum is compressed between the aorta and the overlying superior mesenteric artery. This condition is often chronic and secondary to cachexia. It can trigger further weight loss due to the subsequent proximal intestinal obstruction, causing a positive feedback loop. We report a case of acute presentation of superior mesenteric artery syndrome, complicated by gastric necrosis and treated surgically using the principles of a novel bariatric procedure.
Collapse
Affiliation(s)
- Arno Talboom
- General Surgery, University of Antwerp, Antwerp, BEL
| | - Els Van Dessel
- Abdominal Surgery, Gasthuiszusters Antwerpen, Antwerp, BEL
| |
Collapse
|
7
|
M Koshy R, Chee RKW, Wilson MP, Singh R, Mathew RP, Tu W, Low G. Vascular compression syndromes in the abdomen and pelvis: a concise pictorial review. Abdom Radiol (NY) 2024; 49:1747-1761. [PMID: 38683215 DOI: 10.1007/s00261-024-04315-7] [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: 02/26/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 05/01/2024]
Abstract
Vascular compression syndromes are a diverse group of pathologies that can manifest asymptomatically and incidentally in otherwise healthy individuals or symptomatically with a spectrum of presentations. Due to their relative rarity, these syndromes are often poorly understood and overlooked. Early identification of these syndromes can have a significant impact on subsequent clinical management. This pictorial review provides a concise summary of seven vascular compression syndromes within the abdomen and pelvis including median arcuate ligament (MAL) syndrome, superior mesenteric artery (SMA) syndrome, nutcracker syndrome (NCS), May-Thurner syndrome (MTS), ureteropelvic junction obstruction (UPJO), vascular compression of the ureter, and portal biliopathy. The demographics, pathophysiology, predisposing factors, and expected treatment for each compression syndrome are reviewed. Salient imaging features of each entity are illustrated through imaging examples using multiple modalities including ultrasound, fluoroscopy, CT, and MRI.
Collapse
Affiliation(s)
- Reshma M Koshy
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB, T6G2B7, Canada.
| | - Ryan K W Chee
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB, T6G2B7, Canada
| | - Mitchell P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB, T6G2B7, Canada
| | - Ranjit Singh
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB, T6G2B7, Canada
| | - Rishi P Mathew
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB, T6G2B7, Canada
| | - Wendy Tu
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB, T6G2B7, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB, T6G2B7, Canada
| |
Collapse
|
8
|
Rathod T, Ved YP, Jain D, Patel A. Delayed presentation of Wilkie's syndrome after scoliotic curve correction surgery: a case report. BMC Musculoskelet Disord 2024; 25:329. [PMID: 38658916 PMCID: PMC11044465 DOI: 10.1186/s12891-024-07462-6] [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: 02/12/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare but serious complication following scoliosis correction surgery. It occurs as a result of mechanical compression of third part of duodenum between the SMA and aorta. This condition occurs most commonly in significantly underweight patients with deformities, and usually during the first week following spinal deformity corrective surgeries. The angle between the abdominal aorta and the SMA gets reduced following spinal lengthening during deformity correction surgery causing compression of third part of duodenum resulting in development of SMA syndrome. CASE PRESENTATION We present a case of 17-year-old male with congenital scoliosis with a 70-degree scoliotic curve who underwent spinal deformity correction surgery with posterior instrumented fusion. Post-operative course was uneventful and the patient was discharged after suture removal on post-operative day 15. The patient presented after 21-days of symptom onset on post-operative-day 51, with a 3 week history of post-prandial vomiting, abdominal pain and distension which resulted in rapid weight loss of 11 kg. A CT-angiogram showed obstruction at third part of duodenum. After reviewing clinical and radiological profile of the patient, a diagnosis of SMA syndrome was made. Conservative management was tried, but due to rapid deterioration of patient condition and symptoms of complete intestinal obstruction, the patient was treated surgically by gastro-jejunostomy and side-to-side jejuno-jejunostomy, which improved his condition. CONCLUSION SMA syndrome can occur much later than previously reported cases and with potentially life-threatening symptoms following scoliosis correction. Having a high index of suspicion, early recognition of condition and institution of appropriate treatment are essential to prevent occurrence of severe complications including risk of intestinal perforation and mortality. This case highlights management of delayed onset of SMA syndrome, with presentation further delayed after symptom onset, as is common in developing parts of the world, due to limited availability and accessibility of resources, and low socio-economic status of large segments of the population.
Collapse
Affiliation(s)
- Tushar Rathod
- Department of Orthopaedics, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Yash Prakash Ved
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.
| | - Deepika Jain
- Department of Orthopaedics, Senior Resident Seth G. S. Medical College and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Altamash Patel
- Department of Orthopaedics, Senior Resident Seth G. S. Medical College and K. E. M. Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
9
|
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.
Collapse
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
| | | |
Collapse
|
10
|
Yazdanpanahi P, Keshtkar A, Atighi F, Foroughi M. Duodenojejunostomy following failed gastrojejunostomy in superior mesenteric artery syndrome: A case report. Int J Surg Case Rep 2024; 116:109380. [PMID: 38350373 PMCID: PMC10944004 DOI: 10.1016/j.ijscr.2024.109380] [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: 12/07/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Superior mesenteric artery (SMA) syndrome is a rare duodenal-vascular anatomic disorder leading to external compression on the duodenum. The first step of treatment usually is conservative, and in the case of failure, surgical management is the treatment choice. Treatment success with duodenojejunostomy after failure in gastrojejunostomy can show the uniqueness of this article. CASE PRESENTATION A 14-year-old boy came to our hospital with a complaint of epigastric pain, nausea, bilious vomiting, and weight loss since 6 months ago. Conservation therapy and laparotomic Braun anastomosis and gastrojejunostomy was performed due to the SMA syndrome diagnosis 2.5 months before the admission. At our hospital, an alteration of gastrojejunostomy by duodenojejunostomy employing a diamond-shaped anastomosis between the third portion of the duodenum (D3) and a part of jejunum that was placed 15 cm away from the ligament Treitz was done. A significantly dilated stomach and the first three parts of the duodenum were observed during the procedure. After the second surgical intervention, the general condition of the patient dramatically improved. CLINICAL DISCUSSION Conservative treatment, including nasogastric tube decompression, postural changes, and nutritional support with hyperalimentation, has a variable success rate. However, in some cases, surgery may be necessary. Surgeons prefer laparoscopic duodenojejunostomy due to its outstanding success rate, ranging from 80 % to 100 %. But, in some case reports it is suggested that gastrojejunostomy could be done in cases with severe duodenal dilation instead of duodenojejunostomy. The initial gastrojejunostomy failed because of ongoing symptoms, which was finally revised with a duodenojejunostomy. CONCLUSION It is suggested to use duodenojejunostomy after failure of gastrojejunostomy or it can be employed as the first surgical option even in cases with severe dilation. Because it is a more efficient correction with fewer complications than gastrojejunostomy.
Collapse
Affiliation(s)
- Parsa Yazdanpanahi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Keshtkar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farnaz Atighi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Foroughi
- Department of Pediatric Surgery, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
11
|
Ebrahim MA, Zaher EA, Patel P, Adhikari B, Alvi MS. Chest Pain Redefined: Atypical Presentation of Superior Mesenteric Artery Syndrome. Cureus 2024; 16:e56834. [PMID: 38654789 PMCID: PMC11037557 DOI: 10.7759/cureus.56834] [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: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Superior mesenteric artery (SMA) syndrome is a rare cause of small bowel obstruction characterized by duodenal compression due to the narrowing of the SMA-aorta angle. We present a case of a 43-year-old male with postprandial chest pain, severe weight loss, and a narrowed aortomesenteric angle evident on computed tomography. Conservative management, including hydration, positioning, and weight gain, was initiated, leading to symptom resolution. SMA syndrome diagnosis requires clinical suspicion and radiological confirmation. Understanding this syndrome's varied presentations, diagnostic challenges, and therapeutic approaches is crucial for prompt management, especially when atypical symptoms like chest pain manifest, as seen in our case.
Collapse
Affiliation(s)
| | - Eli A Zaher
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Parth Patel
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Bibek Adhikari
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | | |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Moore ZJ, Eldredge RS, Russell KW. Acute superior mesenteric artery syndrome complicated by severe gastric, pancreatic and renal ischaemia. BMJ Case Rep 2024; 17:e259177. [PMID: 38383132 PMCID: PMC10882347 DOI: 10.1136/bcr-2023-259177] [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] [Indexed: 02/23/2024] Open
Abstract
Superior mesenteric artery syndrome (SMAS) is a rare and potentially life-threatening cause of small bowel obstruction in which the superior mesenteric artery impinges on the third portion of the duodenum. SMAS is typically encountered in patients with low body fat and a history of rapid weight loss and is often diagnosed as a chronic or subacute condition. Here, we describe a case of a healthy adolescent boy without typical SMAS prodromal symptoms presenting with a severe, hyperacute proximal small bowel obstruction due to SMAS. Complications arising from massive gastric and duodenal distension, including gastric, pancreatic and renal ischaemia, necessitated emergent surgical intervention consisting of the duodenojejunostomy bypass with partial gastric resection. The patient recovered without significant lasting consequences.
Collapse
Affiliation(s)
| | - Richard Scott Eldredge
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of General Surgery, Mayo Clinic Arizona, Scottsdale, Phoenix, Arizona, USA
| | - Katie W Russell
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Valeur J, Rickers AL. Narrow angle between superior mesenteric artery and aorta. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2024; 144:23-0756. [PMID: 38349110 DOI: 10.4045/tidsskr.23.0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Affiliation(s)
- Jørgen Valeur
- Lovisenberg Diakonale Sykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
| | | |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|