Superior Mesenteric Artery Syndrome: A Worldwide Descriptive Study with Literature Review

  • Ruhidayati Awaludin Faculty of Medicine, Alexandria University, Alexandria, Egypt.
  • Hazimah Ab Rahim Faculty of Medicine, Alexandria University, Alexandria, Egypt.
  • Dg. Syazana Arivai Faculty of Medicine, Alexandria University, Alexandria, Egypt.
  • Mostafa Refaie Elkeleny 1 Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Keywords: Superior Mesenteric Artery Syndrome, Duodenal Obstruction

Abstract

Background: Superior mesenteric artery syndrome is best described as compression of the third part of duodenum by the superior mesenteric artery, resulting in obstruction. This rare condition has been studied for decades yet remains obscure. This study aimed to analyze different clinical presentations, diagnostic modalities, treatment approaches and outcomes of this condition. Methods: Thirty-five superior mesenteric artery syndrome cases were collected retrospectively from a Facebook group called “Superior Mesenteric Artery Syndrome Awareness & Support”. A questionnaire was designed using Google Forms to obtain the demographics, presenting symptoms, risk factors and co-morbidities, investigations, means of treatment and the outcomes. Data was entered into Microsoft Office Excel for statistical analysis. Results: The median age at diagnosis was 22 years. The median body mass index was 20.8 kg/m2. The median time interval from symptom onset to initial diagnosis was 22 months. The major presenting symptoms were abdominal pain (82.9%), nausea (77.1%), and vomiting (65.7%). Abdominal computed tomography scan with contrast (82.9%) was commonly used for confirmation of diagnosis. Thirteen cases (37.1%) were congenital. Thirty patients (85.7%) had received treatment. The overall management success was only 13.3%. Surgical management (34.3%) was the most commonly used regimen. Conclusion: Diagnosis of superior mesenteric artery syndrome is established after a thorough assessment of the clinical presentations and confirmed with suitable imaging modalities. The choice of treatment should be dependent on the causes and severity as different patients respond differently to therapy. Recurrence is possible in all patients, and a long-term follow up is thus required.

Author Biography

Ruhidayati Awaludin, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

Ruhidayati Awaludin is a final- year medical studentat the Faculty of Medicine, Alexandria University, Egypt.

References

1. Ahmed AR, Taylor I. Superior mesenteric artery syndrome. Postgrad Med J. 1997 Dec;73(866):776-8.
2. Akin JT Jr, Skandalakis JE, Gray SW. The anatomic basis of vascular compres¬sion of the duodenum. Surg Clin North Am. 1974 Dec;54(6):1361-70.
3. Alhadi AN, Shuqdar RM. Anorexia nervosa versus superior mesenteric ar¬tery syndrome in a young woman: case report and literature review. Journal of Taibah University Medical Sciences. 2008;3(1):55-60.
4. Delgadillo X, Belpaire-Dethiou MC, Chantrain C, Clapuyt P, Veyckemans F, de Ville de Goyet J, et al. Arteriomesenteric syndrome as a cause of duodenal obstruction in children with cerebral palsy. J Pediatr Surg. 1997 Dec;32(12):1721-3.
5. Lee TH, Lee JS, Jo Y, Park KS, Cheon JH, Kim YS, et al. Superior mesente¬ric artery syndrome: where do we stand today?. J Gastrointest Surg. 2012 Dec;16(12):2203-11.
6. Lippl F, Hannig C, Weiss W, Allescher HD, Classen M, Kurjak M. Superior
mesenteric artery syndrome: diagnosis and treatment from the gastroente¬rologist's view. J Gastroenterol. 2002 Aug;37(8):640-3.
7. Biank V, Werlin S. Superior mesenteric artery syndrome in children: a 20- year experience. J Pediatr Gastroenterol Nutr. 2006 May;42(5):522-5.
8. Ha CD, Alvear DT, Leber DC. Duodenal derotation as an effective treatment of superior mesenteric artery syndrome: a thirty-three year experience. Am Surg. 2008 July;74(7):644-53.
9. Hines JR, Gore RM, Ballantyne GH. Superior mesenteric artery syn¬drome. Diagnostic criteria and therapeutic approaches. Am J Surg. 1984 Nov;148(5):630-2.
10. Jones PA, Wastell C. Superior mesenteric artery syndrome. Postgrad Med J. 1983 Jun 1;59(692):376-9.
11. Lorentziadis ML. Wilkie's syndrome. A rare cause of duodenal obstruction. Ann Gastroenterol. 2011;24(1):59-61.
12. Raissi B, Taylor BM, Taves DH. Recurrent superior mesenteric artery (Wil¬kie's) syndrome: a case report. Can J Surg. 1996 Oct;39(5):410-6.
13. Wilkie DP. Chronic duodenal ileus. Am J Med Sci. 1927;173(5):643-8.
14. Mathenge N, Osiro S, Rodriguez II, Salib C, Tubbs RS, Loukas M. Superior mesenteric artery syndrome and its associated gastrointestinal implications. Clin Anat. 2014 Nov;27(8):1244-52.
15. Welsch T, Buchler MW, Kienle P. Recalling superior mesenteric artery syn¬drome. Dig Surg. 2007;24(3):149-56.
16. Neri S, Signorelli SS, Mondati E, Pulvirenti D, Campanile E, Di Pino L, et al. Ultrasound imaging in diagnosis of superior mesenteric artery syndrome. J Intern Med. 2005 Apr;257(4):346-51.
17. Zhu ZZ, Qiu Y. Superior mesenteric artery syndrome following scoliosis surgery: its risk indicators and treatment strategy. World J Gastroenterol. 2005 Jun 7;11(21):3307-10.
18. Barnes JB, Lee M. Superior mesenteric artery syndrome in an intravenous drug abuser after rapid weight loss. South Med J. 1996 Mar;89(3):331-4.
19. Merret ND, Wilson RB, Cosman P, Biankin AV. Superior mesenteric ar¬tery syndrome: diagnosis and treatment strategies. J Gastrointest Surg. 2009 Feb;13(2):287-92.
20. Geer DA. Superior mesenteric artery syndrome. Mil Med. 1990 Jul;155(7): 321-3.
21. Ylinen P, Kinnunen J, Hockerstedt K. Superior mesenteric artery syndro¬me. A follow-up study of 16 operated patients. J Clin Gastroenterol. 1989 Aug;11(4):386-91.
22. Bermas H, Fenoglio ME. Laparoscopic management of superior mesente¬ric artery syndrome. JSLS. 2003 Apr-Jun;7(2):151-3.
23. Barner HB, Sherman CD Jr. Vascular compression of the duodenum. Int Abstr Surg. 1963 Aug;117:103-18.
24. Burrington JD. Superior mesenteric artery syndrome in children. Am J Dis Child. 1976 Dec;130(12):1367-70.
25. Wilkie DP. Chronic Duodenal Ileus. Br J Surg. 1921;9(34):204-14.
Published
2016-07-18
How to Cite
Awaludin, R., Ab Rahim, H., Syazana Arivai, D., & Refaie Elkeleny, M. (2016). Superior Mesenteric Artery Syndrome: A Worldwide Descriptive Study with Literature Review. International Journal of Medical Students, 4(2), 50-54. Retrieved from http://ijms.info/index.php/IJMS/article/view/151
Section
Original Article