Superior Mesenteric Artery Syndrome: Diagnosis and Management Techniques
Summary
Superior mesenteric artery syndrome (SMAS) is a rare, potentially life-threatening condition characterised by extrinsic compression of the third portion of the duodenum between the superior mesenteric artery (SMA) and the abdominal aorta. The resulting partial or complete intestinal obstruction manifests as post-prandial pain, nausea, vomiting, early satiety and progressive weight loss. Predisposing factors include rapid weight loss, eating disorders, spinal deformity correction and prolonged immobilisation. Diagnosis requires a high index of clinical suspicion corroborated by imaging—most often contrast-enhanced computed tomography or magnetic resonance imaging—showing a reduced aortomesenteric angle and distance; endoscopic evaluation may provide initial clues. First-line management is conservative: nutritional support to restore retroperitoneal fat, positional therapy and nasogastric decompression. In patients who fail to improve, surgical bypass via duodenojejunostomy (open or laparoscopic) or alternative procedures such as division of the ligament of Treitz can achieve lasting relief. Early recognition and a multidisciplinary approach are vital to prevent chronic malnutrition, reduce morbidity and restore gastrointestinal function.
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Superior Mesenteric Artery Syndrome: Diagnosis and Management Techniques publication trend
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Technical terms
Aortomesenteric angle: The angle between the superior mesenteric artery and the aorta, normally 38–65° and narrowed to <25° in SMAS.
Aortomesenteric distance: The space between the superior mesenteric artery and the aorta, normally 10–28 mm and reduced to <8 mm in SMAS.
Duodenojejunostomy: A surgical bypass creating a direct connection between the duodenum and the jejunum to relieve duodenal obstruction.
Ligament of Treitz: The suspensory muscle of the duodenum; division can alter anatomical tension to relieve compression.
References
- Superior Mesenteric Artery Syndrome in Anorexia Nervosa: A Case Report and a Systematic Revision of the Literature. Nutrients (2024).
- Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings. Gastroenterology Research and Practice (2018).
- Superior Mesenteric Artery Syndrome: Clinical and Radiological Considerations. Surgery Research and Practice (2015).
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