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| ==Background==
| | #REDIRECT[[Superior mesenteric artery syndrome]] |
| *Full name: [[Superior Mesenteric Artery Syndrome]]
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| **AKA: Wilke's syndrome
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| *Rare condition
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| *1st described by Von Rokitansky in 1861 and then further studied in detail by Wilke in 1912
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| *Occurs when the duodenum is compressed between the aorta and the superior mesenteric artery, level of the third portion of the duodenum
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| *Can lead to chronic intermittent or acute, partial or complete gastrointestinal obstruction at the level of the duodenum
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| *Controversy over this diagnosis
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| ==Etiology==
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| *SMA takes off from the abdominal aorta surrounded by fatty and lymphatic tissue also known as the mesenteric pad
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| *The mesenteric pad helps the SMA form an angle of about 45 degrees with the abdominal aorta
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| *Third part of the duodenum courses between the angle formed
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| *Narrowing of this angle can cause entrap and compress of the duodenum
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| **Factors that narrow this angle include:
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| ***Significant weight loss, most common factor
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| ***Corrective spinal surgery for scoliosis lengthens the spine
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| ***Congenital defects, suggested genetic predisposition
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| ***Abdominal adhesions
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| ==Clinical Features==
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| *Early satiety
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| *[[Nausea and vomiting]], can be bilious
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| *[[Abdominal pain]], mid-abdomen which may be improved with changes of position
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| *Abdominal bloating, especially after meals
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| *Bleching
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| *Weight loss
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| *Proximal small bowel obstruction
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| ==Differential Diagnosis==
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| *See [[Abdominal Pain]]
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| *See [[Nausea and vomiting]]
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| ==Evaluation==
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| *Suspected based on signs and symptoms
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| *Diagnosis confirmed by imaging:
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| **Upper GI series
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| **Upper endoscopy
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| **Computed tomography
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| ==Management==
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| *Primary goal is to correct the underlying cause, typically regain lost weight
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| *Acute treatment includes:
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| **Adjusting body position to alleviate symptoms such as knee to chest or lying on left side
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| **Nasogastric decompression
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| **Some patients may require a feeding tube distal to the obstruction or parenteral nutrition
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| *Surgery may be required, options include:
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| **Strong's procedure: duodenum moved to the right of the SMA
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| **Gastrojejunostomy
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| **Duodenojejunostomy
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| ==Disposition==
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| *Depending on the clinical presentation
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| *If complete obstruction, may require admission for decompression and nutrition
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| *Outcome excellent with early diagnosis and appropriate treatment
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| ==See Also==
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| [[Acute gastric dilation]]
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| ==External Links==
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| ==References==
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| <references/>
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| *1. <Karrer FM. Superior Mesenteric Artery Syndrome. Medscape Reference. Jan 2017; http://emedicine.medscape.com/article/932220-overview.>
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| *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.>
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| *3. <Lorentziadis M. Wilke's syndrome. A rare cause of duodenal obstruction. "Ann Gastroenterol." 2011; 24(1): 59-61.
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| [[Category:Vascular]]
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