Superior mesenteric artery syndrome: Difference between revisions
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==Background== | ==Background== | ||
*AKA: Wilke's syndrome | *AKA: Wilke's syndrome | ||
*Rare condition, first described by Von Rokitansky in 1861 and then further studied in detail by Wilke in 1912 | *Rare condition, first described by Von Rokitansky in 1861 and then further studied in detail by Wilke in 1912 | ||
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**Partial or complete | **Partial or complete | ||
*Controversy over this diagnosis | *Controversy over this diagnosis | ||
===Etiology=== | ===Etiology=== | ||
[[File:SMAAnatomy.JPG|thumb|Healthy SMA anatomy]] | [[File:SMAAnatomy.JPG|thumb|Healthy SMA anatomy]] | ||
*SMA takes off from the abdominal aorta at about 45 degree angle, due to cushioning from fatty/lymphatic tissue called mesenteric pad | *SMA takes off from the abdominal aorta at about 45 degree angle, due to cushioning from fatty/lymphatic tissue called mesenteric pad | ||
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**Congenital defects, suggested genetic predisposition | **Congenital defects, suggested genetic predisposition | ||
**Abdominal adhesions | **Abdominal adhesions | ||
==Clinical Features== | ==Clinical Features== | ||
*Early satiety, belching, post-prandial bloating, weight loss | *Early satiety, belching, post-prandial bloating, weight loss | ||
*[[Nausea and vomiting]], can be bilious | *[[Special:MyLanguage/Nausea and vomiting|Nausea and vomiting]], can be bilious | ||
*[[Abdominal pain]], mid-abdomen, may be improved with changes of position | *[[Special:MyLanguage/Abdominal pain|Abdominal pain]], mid-abdomen, may be improved with changes of position | ||
*Proximal [[small bowel obstruction]] | *Proximal [[Special:MyLanguage/small bowel obstruction|small bowel obstruction]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*See [[Abdominal Pain]] | |||
*See [[Nausea and vomiting]] | *See [[Special:MyLanguage/Abdominal Pain|Abdominal Pain]] | ||
*See [[Special:MyLanguage/Nausea and vomiting|Nausea and vomiting]] | |||
==Evaluation== | ==Evaluation== | ||
*Evaluate for alternative causes of symptoms and for complications | *Evaluate for alternative causes of symptoms and for complications | ||
*Suspected based on signs and symptoms | *Suspected based on signs and symptoms | ||
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**Upper endoscopy | **Upper endoscopy | ||
**CT | **CT | ||
==Management== | ==Management== | ||
*Correct [[dehydration]], [[electrolyte abnormalities]], [[malnutrition]] | |||
*Correct [[Special:MyLanguage/dehydration|dehydration]], [[Special:MyLanguage/electrolyte abnormalities|electrolyte abnormalities]], [[Special:MyLanguage/malnutrition|malnutrition]] | |||
*Primary goal is to correct the underlying cause, typically regain lost weight | *Primary goal is to correct the underlying cause, typically regain lost weight | ||
*Acute management: | *Acute management: | ||
**Adjusting body position to alleviate symptoms, such as knee to chest or lying on left side | **Adjusting body position to alleviate symptoms, such as knee to chest or lying on left side | ||
**[[Nasogastric tube]] for decompression | **[[Special:MyLanguage/Nasogastric tube|Nasogastric tube]] for decompression | ||
*Some patients may require a feeding tube distal to the obstruction or parenteral nutrition | *Some patients may require a feeding tube distal to the obstruction or parenteral nutrition | ||
*Surgery sometimes indicated | *Surgery sometimes indicated | ||
**Strong's procedure: duodenum moved to the right of the SMA | **Strong's procedure: duodenum moved to the right of the SMA | ||
**Gastrojejunostomy, duodenojejunostomy | **Gastrojejunostomy, duodenojejunostomy | ||
==Disposition== | ==Disposition== | ||
*Depends on clinical presentation | *Depends on clinical presentation | ||
*If complete obstruction, admission for decompression and nutrition | *If complete obstruction, admission for decompression and nutrition | ||
*Outcome excellent with early diagnosis and appropriate treatment | *Outcome excellent with early diagnosis and appropriate treatment | ||
==See Also== | ==See Also== | ||
*[[Acute gastric dilation]] | |||
*[[Special:MyLanguage/Acute gastric dilation|Acute gastric dilation]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
*1. <Karrer FM. Superior Mesenteric Artery Syndrome. Medscape Reference. Jan 2017; http://emedicine.medscape.com/article/932220-overview.> | *1. <Karrer FM. Superior Mesenteric Artery Syndrome. Medscape Reference. Jan 2017; http://emedicine.medscape.com/article/932220-overview.> | ||
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[[Category:Vascular]] [[Category:GI]] | [[Category:Vascular]] [[Category:GI]] | ||
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Latest revision as of 00:00, 5 January 2026
Background
- AKA: Wilke's syndrome
- Rare condition, first described by Von Rokitansky in 1861 and then further studied in detail by Wilke in 1912
- Occurs when duodenum is compressed between aorta and superior mesenteric artery
- Can lead to gastrointestinal obstruction at level of duodenum
- Chronic, intermittent, or acute
- Partial or complete
- Controversy over this diagnosis
Etiology
- SMA takes off from the abdominal aorta at about 45 degree angle, due to cushioning from fatty/lymphatic tissue called mesenteric pad
- Third part of the duodenum courses between the angle formed
- Narrowing of this angle can cause entrap and compress of the duodenum
- Factors that narrow this angle include:
- Significant weight loss (most common cause)
- Corrective spinal surgery for scoliosis lengthens the spine
- Congenital defects, suggested genetic predisposition
- Abdominal adhesions
Clinical Features
- Early satiety, belching, post-prandial bloating, weight loss
- Nausea and vomiting, can be bilious
- Abdominal pain, mid-abdomen, may be improved with changes of position
- Proximal small bowel obstruction
Differential Diagnosis
- See Abdominal Pain
- See Nausea and vomiting
Evaluation
- Evaluate for alternative causes of symptoms and for complications
- Suspected based on signs and symptoms
- Diagnosis confirmed by imaging:
- Upper GI series
- Upper endoscopy
- CT
Management
- Correct dehydration, electrolyte abnormalities, malnutrition
- Primary goal is to correct the underlying cause, typically regain lost weight
- Acute management:
- Adjusting body position to alleviate symptoms, such as knee to chest or lying on left side
- Nasogastric tube for decompression
- Some patients may require a feeding tube distal to the obstruction or parenteral nutrition
- Surgery sometimes indicated
- Strong's procedure: duodenum moved to the right of the SMA
- Gastrojejunostomy, duodenojejunostomy
Disposition
- Depends on clinical presentation
- If complete obstruction, admission for decompression and nutrition
- Outcome excellent with early diagnosis and appropriate treatment
See Also
External Links
References
- 1. <Karrer FM. Superior Mesenteric Artery Syndrome. Medscape Reference. Jan 2017; http://emedicine.medscape.com/article/932220-overview.>
- 2. <Pleoa A, Constantinescu C, Crumpei F, and Cotea E. Superior mesenteric artery syndrome: an unusual cause of intestinal obstruction. "J Gastrointest Liver Dis". Mar 2006; 15(1): 69-72.>
- 3. <Lorentziadis M. Wilke's syndrome. A rare cause of duodenal obstruction. "Ann Gastroenterol." 2011; 24(1): 59-61.