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Superior Mesenteric Artery Syndrome

Superior mesenteric artery (SMA) syndrome is an uncommon but well recognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum against the aorta by the SMA, resulting in chronic, intermittent or acute complete or partial duodenal obstruction. Clinical symptoms are chronic upper abdominal symptoms such as epigastric pain, nausea, vomiting (bilious or partially digested food), postprandial discomfort and sometimes subacute small bowel obstruction. The stomach can be massively dilated and perforation has been described (Carty et al. 2005; Parker 2003).

An asthenic habitus is noted in about 80% of cases. Other possible etiologic factors are exaggerated lumbar lordosis, depletion of the mesenteric fat caused by rapid severe weight loss, anorexia nervosa, spinal disease or deformity, anatomic anomalies such as abnormally high and fixed position of the ligament of Treitz with an upward displacement of the duodenum and unusually low origin of the SMA and the familial SMA syndrome. An acute form of SMA syndrome is described following scoliosis treatment in which presumably the abrupt straightening of the spine changes the angle a b

Duodenum Straightening

Fig. 5.23. a Enteroclysis in a boy with Crohn disease. The terminal ileum is affected and narrowed with prestenotic dilatation. There is an effacement of the mucosal pattern and septation of loops. Infiltration of the mesenteric fat causes isolation of the terminal ileum. b Crohn disease. CT demonstrates thickened small bowel up to distended cecum. c-e Child with Crohn disease. The US images show an irregular bowel wall thickening and a hyperechoic thickened mesentery

Fig. 5.23. a Enteroclysis in a boy with Crohn disease. The terminal ileum is affected and narrowed with prestenotic dilatation. There is an effacement of the mucosal pattern and septation of loops. Infiltration of the mesenteric fat causes isolation of the terminal ileum. b Crohn disease. CT demonstrates thickened small bowel up to distended cecum. c-e Child with Crohn disease. The US images show an irregular bowel wall thickening and a hyperechoic thickened mesentery c a d b e at which the SMA branches from the aorta causing duodenal compression.

Plain film may show gastric dilatation; however, the stomach may be decompressed by vomiting.

An upper GI tract exam with barium shows a high-grade partial obstruction of the third portion of the duodenum (ORtiz et al. 1990).

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