Facts and fantasies about superior mesenteric artery syndrome: an unusual cause of intestinal obstruction
DOI:
https://doi.org/10.18203/2349-2902.isj20192999Keywords:
Acute angulation, Duodenojejunal anastomosis, SMA syndromeAbstract
Superior mesenteric artery (SMA) syndrome (also known as Wilkie’s syndrome) is an unusual cause of proximal intestinal obstruction, attributable to vascular compression of the third part of duodenum between the superior mesenteric artery and the abdominal aorta due to acute angulation of SMA. It is a life threatening disease as it poses a diagnostic dilemma and often diagnosed by exclusion of other causes. It is an acquired disorder and is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a case of SMA syndrome in a 23 year young asthenic female patient, with a long history of recurrent abdominal pain, epigastric fullness, voluminous vomiting, and weight loss. Symptoms persisted for 1 year and the patient underwent extensive investigations, but to no avail. Thereafter she developed proximal intestinal obstruction, which unravelled her diagnosis. Abdominal examination revealed epigastric fullness, tenderness and hyper peristaltic bowel sounds. We performed small bowel enteroclysis, upper gastrointestinal series, abdominal computer-tomography (CT) and ultrasonography to establish the diagnosis. Conservative treatment was tried for one month but failed. There was no relief of symptoms in the left lateral decubitus or prone position. Finally, the patient successfully underwent Roux-en-Y duodenojejunal anastomosis with a postoperative favourable outcome. This case emphasizes the challenges in the diagnosis of SMA syndrome and the need for increased awareness of this entity. This will improve early recognition in order to reduce irrelevant tests and unnecessary treatments.
References
Record JL, Morris BG, Adolph VR. Resolution of refractory superior mesenteric artery syndrome with laparoscopic duodenojejunostomy: pediatric case series with spectrum of clinical imaging. Ochsner J. 2015;15(1):74-8.
Strong EK. Mechanics of arteriomesenteric duodenal obstruction and direct surgical attack upon etiology. Ann Surg. 1958;148:725-30.
Sapkas G, O’Brien JP. Vascular compression of the duodenum (cast syndrome) associated with the treatment of spinal deformities. A report of six cases. Arch Orthop Trauma Surg. 1981;98:7-11
Wilkie D: Chronic duodenal ileus. Am J Med Sci 1927;173:643-49
Welsch T, Buchler MW, Kienle P: Recalling superior mesenteric artery syndrome. Dig Surg 2007;24:149-156.
Merrett ND, Wilson RB, Cosman P, Biankin AV: Superior mesenteric artery syndrome: diagnosis and treatment strategies. J Gastrointest Surg 2009;13:287-92.
Ahmed AR, Taylor I: Superior mesenteric artery syndrome. Postgrad Med J. 1997;73:776-8.