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3-D angiographic reconstruction of a CECT scan showing the narrowing of the aortomesenteric angle and the reduction of the aorta-SMA distance, in the same patient (patient 1).
Source publication
Background. The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required. Aims and Methods. This study aims at analyzing the clinical presentation, diagnosis, and management of SMA syndrome. Te...
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Background and Objectives
This study examines aortomesenteric angle (AMA) and distance (AMD), critical in superior mesenteric artery (SMA) syndrome. Addressing the scarcity of SMA cases, the research explores potential links with lower body mass index (BMI) and aims to establish normative data for diagnostic and predictive purposes, using contrast-...
Citations
... Jafarpisheh et al. [15] reported a direct and significant association between BMI and both SMA-aorta distance (r = 0.609) and SMA-aorta angle (r = 0.505). Alzewri and colleagues and Sinagra and colleagues also observed significant correlations between BMI and AMA/AMD, affirming our study's findings [26,27] . In a study by Biank et al. [28] , contrary to our findings, a low BMI was not deemed necessary for superior mesenteric artery syndrome (SMAS) development, as only 50% of patients experienced weight loss and decreased BMI before diagnosis. ...
Background and Objectives
This study examines aortomesenteric angle (AMA) and distance (AMD), critical in superior mesenteric artery (SMA) syndrome. Addressing the scarcity of SMA cases, the research explores potential links with lower body mass index (BMI) and aims to establish normative data for diagnostic and predictive purposes, using contrast-enhanced computed tomography (CT) scans across various BMI and sex categories.
Methodology
A retrospective quantitative cross-sectional study was conducted on 189 patients undergoing abdominal contrast-enhanced CT scans between December 2019 and December 2020. Ethical clearance was obtained, and participants provided informed consent. Exclusion criteria targeted specific medical histories. Patient demographics, BMI categories, and imaging data were recorded. Helical 128-slice CT scans were employed, with sagittal-oblique multiplanar reconstructions for parameter assessments. Statistical analysis utilized SPSS 26.0, including Pearson correlation coefficients and mean calculations.
Results
The study reveals a mean AMA of 54.07°±8.53° and a mean distance of 16.25±3.44 mm. Elevated BMI is found to positively correlate with AMA and distance, indicating that higher BMI values may augment these parameters, with an additional positive correlation observed between AMA and distance. No significant correlations are found with patient age or gender.
Conclusion
The study concludes that decreased BMI may pose a potential risk for SMA syndrome, as evidenced by the observed correlations with aortomesenteric parameters. Understanding these normal values in the Nepalese population is critical for accurate diagnoses and predictions using CT scans. The research highlights the impact of demographic factors on these parameters and emphasizes their significance in clinical assessments related to SMA syndrome.
... Jafarpisheh et al. [15] reported a direct and significant association between BMI and both SMA-aorta distance (r = 0.609) and SMA-aorta angle (r = 0.505). Alzewri and colleagues and Sinagra and colleagues also observed significant correlations between BMI and AMA/AMD, affirming our study's findings [26,27] . In a study by Biank et al. [28] , contrary to our findings, a low BMI was not deemed necessary for superior mesenteric artery syndrome (SMAS) development, as only 50% of patients experienced weight loss and decreased BMI before diagnosis. ...
Background and Objectives:
This study examines aortomesenteric angle (AMA) and distance (AMD), critical in superior mesenteric artery (SMA) syndrome. Addressing the scarcity of SMA cases, the research explores potential links with lower body mass index (BMI) and aims to establish normative data for diagnostic and predictive purposes, using contrast-enhanced computed tomography (CT) scans across various BMI and sex categories.
Methodology:
A retrospective quantitative cross-sectional study was conducted on 189 patients undergoing abdominal contrast-enhanced CT scans between December 2019 and December 2020. Ethical clearance was obtained, and participants provided informed consent. Exclusion criteria targeted specific medical histories. Patient demographics, BMI categories, and imaging data were recorded. Helical 128-slice CT scans were employed, with sagittal-oblique multiplanar reconstructions for parameter assessments. Statistical analysis utilized SPSS 26.0, including Pearson correlation coefficients and mean calculations.
Results:
The study reveals a mean AMA of 54.07°±8.53° and a mean distance of 16.25±3.44 mm. Elevated BMI is found to positively correlate with AMA and distance, indicating that higher BMI values may augment these parameters, with an additional positive correlation observed between AMA and distance. No significant correlations are found with patient age or gender.
Conclusion:
The study concludes that decreased BMI may pose a potential risk for SMA syndrome, as evidenced by the observed correlations with aortomesenteric parameters. Understanding these normal values in the Nepalese population is critical for accurate diagnoses and predictions using CT scans. The research highlights the impact of demographic factors on these parameters and emphasizes their significance in clinical assessments related to SMA syndrome.
... S uperior mesenteric artery syndrome (SMAS) is a rare condition that develops from compression of the duodenum between the superior mesenteric artery (SMA) and the abdominal aorta. 1 Loss of intraabdominal adipose tissue narrows the aortomesenteric angle, compressing the third portion of the duodenum passing through. Patients typically present with postprandial abdominal pain, nausea, vomiting, and weight loss. ...
... and the incidence is higher in females. 2 The most common etiologies involve rapid or severe weight loss. 1 However, weight loss is not necessary for the development of SMAS in the pediatric population. 3 A pubertal growth spurt is a risk factor for SMAS. ...
... This normally creates an aortomesenteric angle of 25-60 degrees, with a distance of 10-28 mm between the SMA and aorta. 1 A reduction in adipose tissue narrows the aortomesenteric angle, compressing the third portion of the duodenum as it passes between the aorta and SMA. 1 Symptoms manifest when the angulation is <25 degrees or the aortomesenteric distance is <10 mm. 1 The classical presentation of SMAS includes postprandial abdominal pain, nausea, vomiting, and weight loss. Other symptoms may include early satiety and abdominal distension. ...
Superior mesenteric artery syndrome (SMAS) is a rare condition that develops from compression of the duodenum between the superior mesenteric artery (SMA) and abdominal aorta. SMAS is an atypical complication of restrictive eating disorders. The SMA is supported by adipose tissue to create an aortomesenteric angle that varies from 25-60 degrees. A reduction in adipose tissue causes narrowing of this angle, and SMAS develops when the aortomesenteric angle is narrow enough that it compresses the distal duodenum passing through. Patients present with small bowel obstructive symptoms. We report a severe case of SMAS in an adolescent female with anorexia nervosa who presented with acute and chronic symptoms of bowel obstruction. Awareness of the association between SMAS and restrictive eating disorders can help guide clinical decision-making and prevent delay of diagnosis and serious complications.
... By presenting radiographic evidence of external compression of the third section of the duodenum, SMAS is diagnosed. With the exclusion of other diagnoses, every patient who fulfilled imaging criteria of decreased aortomesenteric angle, diminished aortomesenteric distance, and proximal duodenal dilatation, especially in cases where no water or contrast was administered orally prior to the CT examination, scored 3/3, were identified to have SMA syndromes [14]. UGI series, hypotonic duodenography, CT, or MRA can all be used to show these. ...
Introduction and importance:
Due to a decrease in the aortomesenteric angle, the third section of the duodenum can become acutely or chronically compressed in the superior mesenteric artery syndrome (SMAS).
Case presentation:
A 31-year-old male patient complained of one-year-long recurrent postprandial abdominal pain, periumbilical, intermittent, and colicky. The pain increased in severity in the last 4 months and was relieved only with self-induced vomiting and partially with the knee-to-chest position. A CT scan was done and is most consistent with superior mesenteric artery syndrome. The patient was admitted to the operating room and underwent a successful laparoscopic duodenectomy of the third part of duodenum followed by duodenojejunostomy.
Clinical discussion:
When conservative therapy fails, an open duodenojejunostomy is traditionally advised. A less invasive option that has been documented in up to 10 cases is laparoscopic duodenojejunostomy. We discuss the research on this issue and demonstrate our surgical method on one patient.
Conclusion:
Even if there has been just a modest amount of weight loss, SMAS should be taken into account whenever a sudden observation of gastrointestinal obstruction symptoms is noted in patients with susceptible conditions such as low body weight.
... Spontaneous pneumothorax may also occur in people with AN [50]. However, pneumothorax may be difficult to resolve in people with AN as the lung may remain collapsed for an extended period of time until their state of malnutrition resolves [51]. ...
... Absent the fat pad, the SMA moves medially and compresses the third portion of the duodenum causing a small bowel obstruction. SMA-syndrome generally develops in those with body mass indices (BMI) less than 16 mm/kg 2 and presents with severe epigastric pain fifteen minutes after eating, which is resolved by vomiting [51]. The diagnosis is best made by obtaining an abdominal CT scan or an upper GI series, and specifically alerting the radiologist that the test is being obtained to rule-out SMA syndrome. ...
Plain English summary
People with anorexia nervosa frequent emergency departments to obtain their medical care. It is thus important for emergency department personnel to be familiar with this increasingly common and serious disorder. As opposed to most other mental illnesses, anorexia nervosa is associated with many dangerous medical complications, which become more problematic as the malnutrition and weight loss become more severe. All body systems are adversely affected. The mortality rate of anorexia nervosa is the second highest of all mental disorders, with medical complications and suicide being the top two causes of death. Mandated medical care may occasionally be required to obtain ongoing treatment for people with anorexia nervosa when they present to the emergency department with severe malnutrition and other emergent complications.
... Congenital causes: reduction of the aortomesenteric angle due to a low origin of the SMA that displaces the duodenum cranially or insertional variants of the angle of Treitz [4]. ...
The superior mesenteric artery syndrome is an uncommon entity included in the spectrum of vascular syndromes. The low presentation, variety of in specific symptoms and shortage of bibliography presents a challenging diagnosis for both clinicians and radiologists.
... Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction and is mainly due to the lack or the loss of the mesenteric fat pad leading to the compression of the third part of the duodenum between the aorta and the SMA and usually results in recurrent post-feeds vomiting and weight loss [1]. While SMA syndrome can be the result of hypermetabolic statuses or acute weight loss, we present a case of a newly diagnosed SMA syndrome in the context of tapioca pearl ingestion in a teenage girl. ...
... The normal aortomesenteric angle ranges between 25°and 60°, and an angle of less than 22°is considered one of the diagnostic criteria of SMA syndrome in the proper clinical settings. 9 In this case, improvement of the aortomesenteric angle from 18°to 36°and resolution of SMA syndrome were observed after weight regain. ...
A 19-year-old man diagnosed with diffuse large B-cell lymphoma undergoing chemotherapy presented for recurrent emesis and weight loss. Imaging studies of the abdomen demonstrated features of superior mesenteric artery syndrome. The patient deferred conservative treatment options and was deemed not to be a surgical candidate. Endoscopic ultrasound-guided gastroenterostomy using a lumen-apposing metal stent was performed to bypass the obstruction. Subsequently, the patient's oral intake and weight significantly improved. The stent was removed 6 months after placement with resolution of superior mesenteric artery syndrome symptoms.
... SMAS can be diagnosed radiologically by performing upper gastrointestinal series CT, CT angiography, magnetic resonance angiography, or ultrasonography [18]. When identified in the acute setting, the first-line treatment of SMAS begins with conservative approaches including nasogastric tube placement for gastroduodenal decompression, jejunal or parenteral nutrition to increase retroperitoneal fatty tissue, and positioning into prone or left lateral decubitus position [18]. ...
... SMAS can be diagnosed radiologically by performing upper gastrointestinal series CT, CT angiography, magnetic resonance angiography, or ultrasonography [18]. When identified in the acute setting, the first-line treatment of SMAS begins with conservative approaches including nasogastric tube placement for gastroduodenal decompression, jejunal or parenteral nutrition to increase retroperitoneal fatty tissue, and positioning into prone or left lateral decubitus position [18]. In the case of emergent settings or in symptomatic cases where conservative treatment is insufficient, surgery is indicated. ...
Superior mesenteric artery syndrome (SMAS) is an uncommon condition which is difficult to diagnose due to non-specificity of symptoms. The most common causes of SMAS are severe weight loss secondary to severe medical conditions, surgical history, and cancer. A 31-year-old male with a history of ulcerative colitis status-post proctocolectomy with ileal pouch-anal anastomosis 10 years prior, presented with progressively worsening weight loss and abdominal pain. Radiographic imaging was consistent with SMAS, which was subsequently confirmed intraoperatively during an emergency surgery in which a Roux-En-Y gastrojejunostomy was performed. Clinicians should be aware that SMAS is a rare but possible complication of ileal pouch-anal anastomosis. Although rare, there should be a low threshold for this diagnosis when obstructive symptoms present.
... Superior mesenteric artery syndrome is due a to decreased angle between the origin of the superior mesenteric artery and the abdominal aorta leading to narrowing of the second portion of duodenum and resulting bowel obstruction [1][2][3][4] . Nutcracker syndrome is similar in which the decreased angle between the superior mesenteric artery and the aorta causes external compression of the left renal vein [5][6][7] . ...
Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction. Nutcracker syndrome occurs as the result of external compression of the left renal vein. Although they share a similar pathophysiology, SMA and nutcracker syndrome occurring simultaneously is rare. In this case report, we discuss the pathophysiology and unique computed tomography findings in a 25-year-old female patient diagnosed with SMA syndrome who was also incidentally found to have a coexisting nutcracker phenomenon. Due to similar pathogenesis, radiologists should consider the possibility of coexistence of these rare syndromes in appropriate patients.
