Superior mesenteric

Superior Mesenteric Artery Syndrome (SMAS) is a rare, potentially life-threatening gastro-vascular disorder characterized by the compression of the third part of the duodenum between the abdominal aorta and the overlying superior mesenteric artery. This condition can lead to partial or complete blockage of the duodenum, causing a range of gastrointestinal symptoms. The syndrome is also known as Wilkie's syndrome, cast syndrome, mesenteric root syndrome, or chronic duodenal ileus.

Causes and Risk Factors

The primary cause of SMAS is a reduction in the angle between the superior mesenteric artery and the abdominal aorta, which compresses the duodenum. This can be due to a variety of factors, including significant weight loss, anatomical variations, surgical alterations of the anatomy, or conditions that lead to rapid growth spurts. Other risk factors include spinal deformities and wearing of tight corsets that can alter the normal anatomical relations in the abdomen.

Symptoms

Symptoms of SMAS can vary but often include severe abdominal pain, nausea, vomiting, fullness after eating, and weight loss. In severe cases, it can lead to malnutrition and weight loss due to the inability to properly digest and absorb nutrients.

Diagnosis

Diagnosis of SMAS typically involves a combination of patient history, physical examination, and imaging studies. Computed tomography (CT) scans, magnetic resonance imaging (MRI), and upper gastrointestinal series with barium are commonly used to visualize the compression of the duodenum and the narrowing angle between the superior mesenteric artery and the abdominal aorta.

Treatment

Treatment options for SMAS range from conservative management to surgical intervention. Nutritional support, including enteral nutrition through a nasogastric tube or parenteral nutrition, is often the first step in management. In cases where conservative treatment fails, surgical options such as duodenojejunostomy or gastrojejunostomy may be considered to bypass the obstruction.

Prognosis

The prognosis for individuals with SMAS varies depending on the severity of the condition and the success of treatment. With appropriate management, many patients can recover completely and lead normal lives. However, without treatment, SMAS can lead to serious complications, including malnutrition, electrolyte imbalances, and even death.