Superior mesenteric artery syndrome: a rare cause of intestinal obstruction. Diagnosis and surgical management

Abstract

Superior mesenteric artery syndrome is a rare but well-known clinical entity characterized by compression of the third or transverse portion of the duodenum against the aorta by the superior mesenteric artery, resulting in chronic, intermittent, or acute, complete or partial, duodenal obstruction. The treatment for this arteriomesenteric compression includes conservative measures and surgical intervention. The aim of the study was to evaluate our surgical management and outcomes of the patients with superior mesenteric artery syndrome. The cases with superior mesenteric artery syndrome admitted between January 2000 and January 2010 were retrospectively investigated from the patients' records. All six patients had a history of chronic abdominal pain, nausea, postprandial early satiety, vomiting, and weight loss. Diagnostic methods included barium esophagogastroduodenography, upper gastrointestinal endoscopy, and computed tomography. Medical management was the first step of treatment in all cases before surgery. Of those, four underwent Roux-en-Y duodenojejunostomy and two underwent gastroenterostomy. Postoperative periods were uneventful and mean duration of hospitalization after the operations was 7 days. Conservative initial treatment is usually followed by surgical intervention for the main problem that is the narrowing of the aortomesenteric angle in patients with superior mesenteric artery syndrome. This syndrome should be considered in the differential diagnosis in patients with chronic upper abdominal pain. Duodenojejunostomy is the most frequently used procedure with a high success rate.

Keywords: Diagnosis; Intestinal obstruction; Superior mesenteric artery syndrome; Surgical management.

Fig. 1

Barium meal showing distended stomach and dilated duodenum (150-min appearance)

Fig. 2

The third portion of the duodenum is compressed at the aortomesenteric angle on cross-sectional computed tomographic views (D, duodenum; A, aorta; SMA, superior mesenteric artery)

Fig. 3

Sagittal reconstruction of CT angiography demonstrated an aortomesenteric angle of 15°