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Superior mesenteric artery syndrome
From WikEM
(Redirected from SMA syndrome)
Contents
Background
- AKA: Wilke's syndrome
- Rare condition, first described by Von Rokitansky in 1861 and then further studied in detail by Wilke in 1912
- Occurs when duodenum is compressed between aorta and superior mesenteric artery
- Can lead to gastrointestinal obstruction at level of duodenum
- Chronic, intermittent, or acute
- Partial or complete
- Controversy over this diagnosis
Etiology
- SMA takes off from the abdominal aorta at about 45 degree angle, due to cushioning from fatty/lymphatic tissue called mesenteric pad
- Third part of the duodenum courses between the angle formed
- Narrowing of this angle can cause entrap and compress of the duodenum
- Factors that narrow this angle include:
- Significant weight loss (most common cause)
- Corrective spinal surgery for scoliosis lengthens the spine
- Congenital defects, suggested genetic predisposition
- Abdominal adhesions
Clinical Features
- Early satiety, belching, post-prandial bloating, weight loss
- Nausea and vomiting, can be bilious
- Abdominal pain, mid-abdomen, may be improved with changes of position
- Proximal small bowel obstruction
Differential Diagnosis
- See Abdominal Pain
- See Nausea and vomiting
Evaluation
- Evaluate for alternative causes of symptoms and for complications
- Suspected based on signs and symptoms
- Diagnosis confirmed by imaging:
- Upper GI series
- Upper endoscopy
- CT
Management
- Correct dehydration, electrolyte abnormalities, malnutrition
- Primary goal is to correct the underlying cause, typically regain lost weight
- Acute management:
- Adjusting body position to alleviate symptoms, such as knee to chest or lying on left side
- Nasogastric tube for decompression
- Some patients may require a feeding tube distal to the obstruction or parenteral nutrition
- Surgery sometimes indicated
- Strong's procedure: duodenum moved to the right of the SMA
- Gastrojejunostomy, duodenojejunostomy
Disposition
- Depends on clinical presentation
- If complete obstruction, admission for decompression and nutrition
- Outcome excellent with early diagnosis and appropriate treatment
See Also
External Links
References
- 1. <Karrer FM. Superior Mesenteric Artery Syndrome. Medscape Reference. Jan 2017; http://emedicine.medscape.com/article/932220-overview.>
- 2. <Pleoa A, Constantinescu C, Crumpei F, and Cotea E. Superior mesenteric artery syndrome: an unusual cause of intestinal obstruction. "J Gastrointest Liver Dis". Mar 2006; 15(1): 69-72.>
- 3. <Lorentziadis M. Wilke's syndrome. A rare cause of duodenal obstruction. "Ann Gastroenterol." 2011; 24(1): 59-61.
