Superior Mesenteric Artery Syndrome: An Uncommon Cause of Intestinal Obstruction

Ulises Baltazar, MD, Julie Dunn, MD, Carlos Floresguerra, MD, Larry Schmidt, MD, and William Browder, MD, Departments of Surgery and Gastroenterology, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tenn

South Med J. 2000;93(6) 

In This Article

Abstract and Introduction

Abstract

Superior mesenteric artery (SMA) syndrome is an atypical cause of high intestinal obstruction, most frequently occurring in patients who have had rapid weight loss. Identification of this syndrome can be a diagnostic dilemma and is frequently made by exclusion. The most characteristic symptoms are postprandial epigastric pain, eructation, fullness, and voluminous vomiting. The symptoms are caused by compression of the third portion of the duodenum against the posterior structures by a narrow-angled SMA. When nonsurgical management is not possible or the problem is refractory, surgical intervention is necessary. We report a case of SMA syndrome in a patient without a history of rapid weight loss. The patient complained of early satiety, nausea, and vomiting of partially digested food worsening over 2 years. Diagnostic evaluation revealed compression of the third portion of the duodenum by the SMA with resultant proximal dilatation. The patient successfully had duodenojejunal anastomosis.

Introduction

Superior mesenteric artery syndrome was first described in the 1800s by Rokitansky.[1,2] It is also known as arteriomesenteric duodenal compression, chronic duodenal ileus, the cast syndrome, and Wilkie's syndrome.[2] The syndrome often develops after a rapid and dramatic weight loss and often is construed as a psychologic problem. Nevertheless, it is a true entity that often presents a diagnostic dilemma, frequently one of exclusion. The most characteristic symptoms are postprandial epigastric pain, eructation, fullness, and voluminous vomiting. The most common cause is a reduction in the angle formed by the SMA and the abdominal aorta, which causes entrapment of the third portion of the duodenum.[3] This syndrome can occur as an acute illness but more commonly appears as a chronic condition.[4] The first surgical treatment was proposed by Bloodgood, when he described duodenojejunostomy.[2] About 400 cases have been reported in the English language since the late 1800s, making this an unusual cause of upper intestinal obstruction.[1,3]

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