Laparoscopic treatment of superior mesenteric artery syndrome.

BACKGROUND: Superior mesenteric artery syndrome is caused by compression of the third portion of the duodenum by the superior mesenteric artery. Many disease states predispose one to this condition. METHODS: We present a case report of a young female patient who presented with gastro-duodenal obstruction from superior mesenteric artery syndrome and subsequently underwent surgical treatment with minimally invasive techniques. Pathophysiology of SMA syndrome is reviewed. RESULTS: The cause of superior mesenteric artery syndrome is variable but always results in duodenal obstruction. Surgery is one treatment option that is effective and can be performed laparoscopically. CONCLUSION: Laparoscopic duodenojejunostomy is an acceptable method of treating superior mesenteric artery syndrome.     

Superior mesenteric artery syndrome after lung transplantation: a rare early gastrointestinal complication of lung transplantation

Gastrointestinal complications sometimes occur after lung transplantation and remain a cause of postoperative morbidity. Superior mesenteric artery syndrome is caused by the compression of the duodenum by the superior mesenteric artery, but few reports have described superior mesenteric artery syndrome after lung transplantation. We herein report two cases of superior mesenteric artery syndrome as an early complication after lung transplantation. Both patients were emaciated and had lost weight before transplantation. They also lost an additional 2–4 kg early after transplantation. They were medically treated with enteral nutrition and recovered without recurrence of the syndrome. Since critically ill patients with pulmonary disease usually lose weight both before and early after lung transplantation, superior mesenteric artery syndrome is important to consider in the differential diagnosis of gastrointestinal complications after transplantation.     

Aorto-mesenteric compression syndrome. Description of clinical case and critical review of the literature]

Aorto-mesenteric duodenal compression syndrome is a rare disease in which superior mesenteric artery causes a substenosis of the duodenum. Pathogenesis of this syndrome is due to congenital or acquired factors. Symptomatology is usually non specific and intermittent. Diagnosis is given by selective superior mesenteric artery angiography. Therapy is only surgery.     

Superior mesenteric artery syndrome following spinal deformity correction

BACKGROUND: Superior mesenteric artery syndrome is a known complication associated with the correction of spinal deformity. Recent investigations of this disorder have focused on patient height and weight. We are not aware of any published study examining the degree of deformity, type of curve, or magnitude of correction, and to our knowledge all of the reported literature on this syndrome lacks control data. The purpose of this study was to examine the relationship between the correction of spinal deformity and the development of superior mesenteric artery syndrome in patients with scoliosis. Our hypothesis was that greater correction of spinal deformity would increase the risk of the development of superior mesenteric artery syndrome. METHODS: A case-control study was performed over a five-year period. The primary outcome measure was the development of superior mesenteric artery syndrome. The predictor variables that were considered included demographic characteristics; preoperative height, weight, and body mass index; aspects of the deformity, including curve magnitude, Lenke curve classification, and correction; and operative factors, including surgical approach, estimated blood loss, and the presence of operative hypotension. RESULTS: A review of the records on 364 surgical procedures for scoliosis identified seventeen cases of superior mesenteric artery syndrome. Thirty-four subjects who had had surgery for scoliosis but no superior mesenteric artery syndrome were randomly selected as controls. Eight of the seventeen subjects with superior mesenteric artery syndrome had undergone a two-stage procedure (compared with one of the thirty-four controls, p < 0.001), nine of the seventeen had had combined anterior and posterior procedures (compared with two of the thirty-four controls, p < 0.001), and seven of the seventeen had had a thoracoplasty (compared with two of the thirty-four controls, p < 0.001). No significant differences were noted between the groups with regard to demographic factors. Compared with the controls, the patients in whom superior mesenteric artery syndrome developed were shorter (by a mean of 7.1 cm, p = 0.03), weighed less (by a mean of 11.5 kg, p = 0.001), had a lower body mass index (p = 0.003), had a greater minimal thoracic curve magnitude achieved by bending (a mean of 12 degrees greater [45 degrees for subjects with superior mesenteric artery syndrome and 33 degrees for controls], p = 0.015), had a lower percent correction of the thoracic curve on bending (a mean of 11% lower, p = 0.025), and had more lumbar lateralization (88%, compared with 61% in the control group, had a Lenke lumbar modifier of B or C instead of A, p = 0.008). Multivariate logistic regression analysis identified a staged procedure (odds ratio, 31.0), the lumbar modifier (odds ratio, 9.06), body mass index (odds ratio, 7.75), and thoracic stiffness (odds ratio, 6.67) as the most predictive of the development of superior mesenteric artery syndrome. CONCLUSIONS: Preoperative identification of the risk factors described above in conjunction with preoperative nutritional maximization should be considered in order to limit the prevalence of superior mesenteric artery syndrome in patients undergoing surgical correction of spinal deformity.     

Infrarenal transposition of the superior mesenteric artery: a new approach in the surgical therapy for Wilkie syndrome

The superior mesenteric artery syndrome, also known as Wilkie syndrome or as arteriomesenteric obstruction of the duodenum, is a rare condition of upper intestinal obstruction in which the third part of the duodenum is compressed by the overlying, narrow-angled superior mesenteric artery against the posterior structures. It is characterized by early satiety, recurrent vomiting, abdominal distention, weight loss, and postprandial distress. When nonsurgical management is not possible or the problem is refractory, surgical intervention is necessary. Usually a laterolateral duodenojejunostomy or Roux-en-Y reconstruction for reconstruction of the intestinal passage is performed. We report the first successful transposition, to our knowledge, of the superior mesenteric artery into the infrarenal aorta in the therapy of Wilkie syndrome.     

Portal venous gas and thrombosis complicating superior mesenteric artery syndrome (Wilkie's syndrome) in a child

We report a case of a 10-year-old girl presenting with portal venous gas and thrombosis associated with superior mesenteric artery syndrome. To our knowledge, this is the first reported case of superior mesenteric artery syndrome complicated by gastric wall pneumatosis, portal venous gas, and thrombosis in childhood. Although these complications usually lead to bowel resection in adults and result in a high mortality rate, our pediatric patient was successfully treated nonoperatively with intensive care management and jejunal tube feedings. Presence of portal venous gas may occur in superior mesenteric artery syndrome in children and does not necessarily lead to bowel injury, allowing conservative medical management as a first-line treatment.     

Laparoscopic repair of superior mesenteric artery syndrome.

BACKGROUND: Superior mesenteric artery syndrome is duodenal obstruction by the superior mesenteric artery. It is caused by decreasing the angle between the aorta and superior mesenteric artery causing compression of the third part of the duodenum and usually occurs after a period of weight loss. METHODS: Between September 1999 and April 2000, 2 patients with superior mesenteric artery syndrome were treated laparoscopically. The laparoscope was placed in the umbilicus; the surgeon operated through two trochars on the left side of the abdomen, and an assistant retracted through one trochar on the right side of the abdomen. The dilated duodenum was seen below the transverse mesocolon and to the right of the superior mesenteric artery. A proximal loop of jejunum was anastamosed to the duodenum using the endoscopic gastrointestinal anastomotic (GIA) stapler. RESULTS: Average operating time was 113 minutes and average hospital length of stay was 3 days. There were no complications and both patients were pleased with their results. CONCLUSIONS: Laparoscopic duodenojejunal bypass is feasible with laparoscopic techniques. The operating time is acceptable and the postoperative length of stay is short.     

Superior Mesenteric Artery Syndrome: A Rare Cause of Intestinal Obstruction. Diagnosis and Surgical Management

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.     

Dunbar's syndrome and aorto-mesenteric compression. A casual association?

Celiac artery compression syndrome and superior mesenteric artery syndrome are two rare diseases, extensively documented in the literature, with a pathogenesis which is still controversial. Their association never been carefully studied and only one such case has been reported. For this reason we reviewed our experience from january 1974 to december 2000, including 57 patients diagnosed with coeliac artery compression syndrome and 27 patients with superior mesenteric artery syndrome. We found the presence of both syndromes in 6 patients. All 6 were submitted successfully to a duodeno-jejunal bypass and decompression of the coeliac artery. In this paper we analyse the pathogenesis, clinical presentation, diagnosis and treatment of these syndromes emphasising their common aspects. The association of the coeliac artery compression syndrome and superior mesenteric artery syndrome has never been thoroughly studied because of their rarity. The lack of recognition of this association may, in some cases, justify the controversial results reported in the surgical treatment of these syndromes.     

Inferior mesenteric artery aneurysm in Behçet syndrome

We present a case report of an aneurysm of the inferior mesenteric artery, associated with occlusion of the celiac, superior mesenteric, and left renal arteries and severe stenosis in the right renal artery, in a 48-year-old patient with Beh?et syndrome. The meandering inferior mesenteric artery, with an aneurysm 28 mm in greatest dimension, was the blood supply source for the intraperitoneal viscera. Aneurysm resection and reimplantation of the inferior mesenteric artery, and right renal artery bypass grafting with saphenous vein was performed. To our knowledge, this is the first reported case of inferior mesenteric artery aneurysm caused by Beh?et syndrome.     

A case of superior mesenteric artery syndrome after left nephrectomy

Postoperative superior mesenteric artery syndrome is a rare complication of left nephrectomy. We treated a case of superior mesenteric artery syndrome that occurred 7 days after radical left nephrectomy for renal cell carcinoma. The patient was a 54-year-old Japanese man who presented with gross hematuria. Abdominal computed tomography showed a 3.8 x 3.8 x 5 cm heterogeneous cystic mass in the left kidney. Transperitoneal left radical nephrectomy was performed because renal cell carcinoma was suspected. The patient resumed oral intake 3 days after surgery, but he began vomiting repeatedly from the 7th day after surgery. Gastroduodenography showed an abrupt vertical linear obstruction of the third portion of the duodenum. Superior mesenteric artery syndrome was diagnosed. Conservative therapy (indwelling nasogastric tube, intravenous hyperalimentation and postural changes) was effective.     

Obstruction of the duodenum by the superior mesenteric artery — Does it exist in children?

Though well described by rokitansky in 1861, the symptoms and treatment of duodenal compression by the superior mesenteric artery have not been clearly defined in children. As a result, diagnosis and therapy may be unduly delayed. This report is of personal experience with superior mesenteric artery (SMA) syndrome in 20 children. Seven of these cases have been discussed previously.     

"Cast syndrome"

The term "cast syndrome" (also called Wilkie's syndrome or superior mesenteric artery syndrome) means an intestinal obstruction caused by a duodenal vascular compression from the superior mesenteric artery. A case of this rare syndrome is reported in a 12-year-old child associated with the treatment by a plastered cast for idiopathic scoliosis. The pathogenesis, diagnosis, medical and surgical treatment are described.     

Superior mesenteric artery syndrome: A diagnosis to be kept in mind (Case report and literature review)

IntroductionSuperior mesenteric artery (SMA) syndrome or what is called Wiklie’s syndrome is one of the rare causes of small bowel obstruction. Its exact incidence is not known. It is due to decrease in Aortomesenteric angle.Case presentationA thirty-Four-year old male patient presented to our accident and emergency (department) with 3 days history of epigastric pain, which was not radiating anywhere. It had no aggravating or relieving factors. Patient complained of repeated attack of vomiting as well. Contrast enhanced Computed tomography (CT) showed duodenal obstruction caused by superior mesenteric artery compression on 3rd part of duodenum.DiscussionSuperior mesenteric artery syndrome (SMA) is one of the rare causes of small bowel obstruction. Incidence of superior mesenteric artery syndrome reported in literature is ranging from 0.1 to 0.3%. The most common cause is significant weight loss which leads to loss of retroperitoneal fat. Treatment usually is conservative but surgical intervention should be considered if that failed.ConclusionSuperior mesenteric artery syndrome is a rare cause of intestinal obstruction but should be kept in mind. Persistent vomiting after history of weight loss should raise the suspicion of this diagnosis. Upper GI endoscopy may be necessary to exclude mechanical causes of duodenal obstruction. Contrast enhanced CT scan is useful in the diagnosis of superior mesenteric artery syndrome and can provide diagnostic information.     

Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome

Superior mesenteric artery syndrome (Wilkie's syndrome) causes acute or chronic compression of the third part of the duodenum. Initially conservative treatment is tried, but on failure of treatment, duodenojejunostomy is the procedure of choice, usually done by open surgery. We present a case of superior mesenteric artery syndrome in which the duodenojejunostomy was done laparoscopically.     

Superior mesenteric artery syndrome following small bowel resection

Superior mesenteric artery syndrome is a rare cause of mechanical intestinal obstruction. It results from compression of the third part of the duodenum between the superior mesenteric artery and the aorta. It has been described in association with a variety of clinical conditions, including prolonged supine immobilization, application of a body cast, ileal pouch-anal anastomosis, abdominal aortic aneurysm, spinal surgery and severe weight loss. We present a case of superior mesenteric artery syndrome following resection of a primary adenocarcinoma of the small bowel.     

Aneurysm of a jejunal branch of the superior mesenteric artery in a patient with Marfan's syndrome

A case of post-traumatic aneurysm of a jejunal branch of the superior mesenteric artery in a patient with Marfan's syndrome is reported. Ascending aortic involvement is well known in Marfan's syndrome but no association with visceral artery aneurysms has been previously described. The blunt abdominal trauma preceding the detection of the aneurysm may have been the precipitating cause in a predisposed patient. Because of the high risk of rupture, aneurysms of the superior mesenteric artery branches should be treated. Excision or ligation without restoring continuity are the most common surgical procedures; endovascular embolization is an alternative option especially in high risk patients.     

Superior mesenteric artery syndrome as a rare cause of duodenal obstruction

Superior mesenteric artery syndrome is a rare cause of duodenal obstruction. The syndrome can present as acute small bowel obstruction or intermittent compression symptoms such as postprandial epigastric pain, fullness or vomiting. The obstruction is caused by compression of the third part of the duodenum against the posterior structures by the narrow‐angled superior mesenteric artery. The diagnosis is easily confused with gastric outlet obstruction or proximal small bowel obstruction. A high index of clinical suspicion is crucial for diagnosis and computed tomography provides confirmatory evidence. We report two cases of superior mesenteric artery syndrome and a review of the literature for this condition.     

Duodenojejunal junction web masquerading as Wilkie’s syndrome: Report of a case

Wilkie’s syndrome (superior mesenteric artery syndrome) is a rare cause of obstruction to the third part of duodenum due to compression between the superior mesenteric artery and the abdominal aorta. Pathologies like malignant growth in the mesenteric root, the presence of a lymph nodal mass compressing the terminal duodenum, dissecting aortic aneurysm, and intestinal malrotation may mimic the condition, but are not true etiologies of the syndrome. A duodenojejunal web causing narrowing of the duodenojejunal junction and mimicking Wilkie’s syndrome has not been described before in the literature. We herein report a case of gastroduodenal obstruction due to a web in the duodenojejunal junction in a young female patient, which closely mimicked Wilkie’s syndrome but was finally diagnosed postoperatively. We highlight the first case of its kind in an adult and discuss the challenges in both the diagnosis and management.     

External compression of the superior mesenteric artery by the median arcuate ligament

The median arcuate ligament can compress the proximal portion of the celiac artery causing symptoms of chronic mesenteric ischemia. This rare condition typically affects young women and often poses a diagnostic challenge. Compression of the superior mesenteric artery (SMA) in addition to the celiac artery represents an unusual variant of median arcuate ligament syndrome (MALS). We present a case of MALS resulting predominantly from external compression of the SMA. Diagnostic and therapeutic options are discussed.