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Barium meal showing distended stomach, first and second part of duodenum (*) with abrupt cutoff at third part of duodenum (red line)
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Superior mesenteric artery (SMA) syndrome, though rare, should be considered in patients with duodenal obstruction with no other causes. History of recent weight loss and imaging modalities help in the diagnosis. Conservative management can be tried before going for surgery. Superior mesenteric artery (SMA) syndrome, though rare, should be consider...
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Superior mesenteric artery (SMA) syndrome is defined as a narrowed space and decreased angle between the SMA and aorta leading to partial or complete obstruction of the third portion of the duodenum. SMA syndrome patients may have comorbid conditions associated with extreme weight loss, hypermetabolism or malnutrition. We present the case of a 55-y...
Superior mesenteric artery (SMA) syndrome, also known as Cast syndrome, Wilkie's syndrome, or duodenal ileus, is a rare condition involving compression of the duodenum between the aorta and the SMA, primarily attributed to loss of the intervening mesenteric fat pad. Clinical symptoms include postprandial epigastric abdominal pain, nausea, emesis, a...
Superior mesenteric artery syndrome (SMAS), which is also known as the cast syndrome, Wilkie’s syndrome, or chronic duodenal ileus, is a specific type of duodenal obstruction characterized by the obstruction of the inferior part of the duodenum due to its compression between the superior mesenteric artery (SMA) and the aorta. This problem is usuall...
Wilkie syndrome represents a rare cause of intestinal obstruction due to external compression of the third duodenal portion by the superior mesenteric artery. We present a 68-year-old woman who came to the consultation for frequent bilious vomiting, abdominal distension and marked weight loss. Extrinsic duodenal compression was evidenced in its thi...
Background
Superior mesenteric artery syndrome (SMAS) occurs when the third portion of the duodenum is compressed between the superior mesenteric artery (SMA) and the aorta, causing duodenal obstruction. This condition most commonly arises from marked weight loss that reduces the size of the fat pad between these vessels, causing greater acuity of...
Citations
... A total of 13 cases were identified for 10 years, from January 2010 to November 2020 ( Table 1). Citation: [13][14][15][16][17][18][19] The mean age of patients was 32 years. The male-to-female ratio was 7:6. ...
Small bowel obstruction has many etiologies, but superior mesenteric artery syndrome (SMAS) is among the rarest causes. It happens when the third part of the duodenum is compressed between the superior mesenteric artery and the abdominal aorta, preventing gastric content from passing through the small intestine. SMAS is a diagnosis of exclusion because it is atypical and needs a high index of suspicion. There is frequently a delay in diagnosis, leading to morbidity and mortality. We present a case of a young female who presented with symptoms of episodic abdominal pain and obstruction. A computed tomography scan revealed SMAS. She was admitted and treated conservatively with total parenteral nutrition for one week and intravenous fluids, and eventually, her bowel opened, and the condition resolved.
... Superior mesenteric artery syndrome (SMAS) is a rare condition resulting from vascular compression, in which, the third part of the duodenum is compressed between the aorta and the superior mesenteric artery [1]. In fact, many predisposing factors for SAMS, with a potential impact on the aortomesenteric angle, have been identified. ...
... In fact, a CT scan can calculate the angle between the AMS and the aorta, which is reduced between 7° to 22°, whereas it is normally between 38° and 65°. The aorto-mesenteric distance is also reduced and generally measures between 2-8 mm, while the normal distance is 10 to 28 mm [1]. A diagnosis of SAMS must be deduced with caution since it is generally confirmed after the presence of symptoms of SAMS associated with an aortomesenteric angle <22-25° and an aortomesenteric distance <8 mm [4] . ...
Superior mesenteric artery syndrome-induced pancreatitis is rarely reported .We report a case which can be explained by an occlusive post-papillary syndrome, which produces retrograde reflux of bile into the pancreatic duct, activating inflammation responsible for pancreatitis.
... 2 Computed tomography (CT) enables clear visualization of vascular compression of the third horizontal part of duodenum by the SMA and also helps in measuring aortomesenteric angle and distance. 1,3 Normally, the aortomesenteric angle and aortomesenteric distance measure 28-65° and 10-34 mm; in SMA syndrome, both parameters are reduced with values of 6° to 22° and 2 to 8 mm. 4 Reduced fat between the SMA and aorta either due to poor nutritional intake or weight loss results in reduced aortomesenteric angle and distance. 2.4 Most of the patients diagnosed with SMA syndromes are managed conservatively, with surgery reserved for refractory cases not responding to medical treatment. ...
Objectives:
To determine the prevalence of superior mesenteric artery (SMA) syndrome in patients presenting with abdominal pains, and to evaluate computed tomographic (CT) findings needed for its diagnosis.
Methods:
This retrospective record-based study was carried out at the radiology department, from January 2016 to January 2021. All young patients (aged under 25) who underwent CT scans for abdominal pains were reviewed. Post-surgery, tumor, and trauma cases were excluded. Imaging findings for SMA syndrome were recorded as ‘suggestive’ (reduced aortomesenteric angle and distance with proximal duodenal dilatation), ‘possible’ (reduced angle and distance without proximal duodenal dilatation) and ‘probable’ (reduction of either angle or distance). Two radiologists interpreted the findings and consensus reporting was made. Diagnoses were confirmed on clinical grounds (symptomatic improvement by specific treatment and exclusion of other diagnoses), or barium studies. Imaging findings were compared to final diagnoses. McNemar’s Chi-square test was used to determine association.
Results:
Out of 141 patients (mean age=10.8, standard deviation=4), 7 (4.9%) patients mostly females were having SMA syndromes based on ‘suggestive’ imaging criteria (p=0.0005), and one patient underwent surgery.
Conclusion:
Superior mesenteric artery syndrome is not an uncommon condition and should be considered in differential diagnosis of acute abdomen in young patients after excluding other diagnoses.
... Besides, unusual body shape is a rare risk factor for small bowel obstruction. In patients with skinny body shape, superior mesenteric artery syndrome should be considered, whose duodenum was compressed between the aorta and the superior mesenteric artery [3] . In our case of ankylosing spondylitis and scoliosis, the patient's duodenum went wrong direction due to torturous body shape and smaller abdominal cavity. ...
Small bowel obstruction is a blockage in the small intestine, which is usually caused by adhesion scar tissue, hernia, medication, or malignancy. The symptoms of small bowel obstruction include nausea and vomiting of bile, abdominal distention and obstipation. We present a case of a 61-year-old man with ankylosing spondylitis and scoliosis, who suffered from incomplete small bowel obstruction due to unusual direction of duodenum and externally compressed by liver, gallbladder and pancreas. We gave conservative treatment and inserted a nasojejunal tube for enteral feeding, and the duodenum broke free from the grip of liver, gallbladder and pancreas to its normal anatomical direction. Besides common etiology of small bowel obstruction, unusual body shape and smaller abdominal cavity may cause obstruction due to external compression of neighbor organs. Conservative treatments include gastrointestinal decompression, correction of electrolytes abnormality and nutrition support, while surgical intervention is suggested for the patient without improvement on conservative management.
... Wilkie's Syndrome (WS) also known as Superior Mesenteric Artery Syndrome [1] is a very rare disease caused by aortomesenteric space (AMS) reduction resulting in duodenum compression [2] . It can be congenital or acquired. ...
Wilkie's Syndrome is a very rare disease caused by reduction of aorto-mesenteric space with consequent duodenum compression. It can combine with left renal vein stenosis which, when symptomatic, is known as "Nutcracker Syndrome". We describe a clinical onset case with epigastric pain without vomiting in a normal weight patient. 28-year-old woman who came to our observation for intense epigastric pain after a weight loss of 14 kg in 4 months. Multidetector Computed Tomography and Ultrasound revealed gastric and duodenal overdistension with hydro-air levels, severe duodenum stenosis, and left renal vein compression. Wilkie's Syndrome is common in anorexic individuals suffering from recurrent postprandial vomiting, onset with severe epigastric pain, without vomiting, is quite unusual. High-calorie diet must be first therapeutic approach, in case of failure treatment of first choice should be endovascular stenting and, only in selected cases, surgical treatment should be used because it is very invasive and burdened with numerous complications. Failure to diagnose this disease can expose patients to serious health risks.
Superior mesenteric artery syndrome (SMAS) is a rare clinical disease caused by obstruction of the duodenum at the angle between the abdominal aorta and superior mesenteric artery. We report a male patient admitted to our hospital with a chief complaint of obvious postprandial vomiting and nausea. SMAS was confirmed by abdominal computed tomography images and clinical symptoms. After admission, the patient was treated with fasting, antibiotics, fluid resuscitation, parenteral nutrition, and other conservative treatments. However, the patient deteriorated rapidly and died because of multiple organ failure. SMAS is easily missed, which may delay timely treatment. Clinicians should improve their clinical understanding of SMAS.
Introduction. Wilkie syndrome is a pathological manifestation caused by an abnormal disorder of the superior mesenteric artery arising from the abdominal part of the aorta. As a result, the distal part of the duodenum is compressed between the abdominal aorta, spine, and SMA, which creates a hindrance for the passage of himus in the duodenum, creating a mechanical obstruction.
Aim : To draw the surgeons’ attention towards the possibility of developing a rare complication of decreased aorto-mesenteric angle and the distance, highlighting the challenges in diagnosis and treatment.
Materials and methods . This article presents a clinical case of WS diagnosed in the surgical department of the BSMU clinic. We hereby discuss the case report of a 28-year-old patient diagnosed at the initial stage of WS. The patient had been suffering from the symptoms of WS since 2018 but wasn’t able to identify the disease, but when he came to the surgical department of BSMU clinic based on the results of abdominal CT-scan with combined contrast of the stomach and duodenum per os with water-soluble contrast and computer angiography of the mesenteric vessels, the diagnosis was confirmed. The patient was treated with the duodenojejunostomy (laparoscopic Strong’s operation).
Results and discussion . Absence of timely diagnosis of this disease can lead to life-threatening complications, and early diagnostics is complicated by similarity of initial manifestations with other gastropancreaticoduodenal diseases. One of the most promising approach in the diagnosis of Wilkie syndrome is the use of abdominal CT-scan with combined contrasting of the stomach and duodenum per os with water-soluble contrast and computer angiography of vessels. In the present clinical case due to the given combination of methods we can assess functional state of the stomach and duodenum, clearly visualize not only the organs topography but also estimate the aorto-mesenteric angle and distance, which can further determine the type and tactics of initial stage treatment, which we decided to perform surgery (laparoscopic Strong’s operation). The postoperative period was without complications. The patient noted an improvement in the state and the relief of pain in the epigastrium and was discharged after 9 days of hospitalization in satisfactory condition.
Conclusion . For diagnosis and treatment in time as well as prevention of possible complications, it is necessary to improve surgeons’ information about this pathology, which if diagnosed and treated late can lead to severe, life-threatening complications up to death. The diagnosis at the initial stages, specifically with the assistance of computer tomography with contrast, angiography, and treatment in a timely manner, can preserve life and prevent the possible outcomes of fatal complications.
