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Sagittal view of an abdominal ultrasound taken prior to nasogastric tube placement. An almost parallel aorta and SMA are seen with a very compressed duodenum passing in between the two vascular structures
Source publication
Superior Mesenteric Artery (SMA) syndrome is an uncommon condition caused by mechanical obstruction of the distal third of the duodenum between the superior mesenteric artery and the abdominal aorta. SMA syndrome is associated with both operative and non-operative corrections of scoliosis, as well as anorexia nervosa, severe weight loss, tumors, bu...
Context in source publication
Context 1
... abdominal ultrasound revealed a markedly dilated stomach with the gastric fundus extending down to the level of the aortic bifurcation. On the sagittal images, the superior mesenteric artery course was nearly parallel to the course of the abdominal aorta, such that there was very little space between the two vessels for the transverse duodenum to remain patent (Figure 4). ...
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Introduction
Knowledge of celiac artery variations is imperative to perform complex hepato-biliary pancreatic surgical procedures to avoid inadvertent complications. Multi-detector computed tomographic (MDCT) angiography aids in detecting these variations preoperatively. Surgical confirmation is considered the gold standard.
Aims and objectives
Pre...
Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction that can go undiagnosed, exacerbating weight loss in an already significantly malnourished patient. Diagnosis is often challenging, however, can be made by keeping a high index of suspicion based on the clinical presentation. The pathology involves a reduction in the...
Superior mesenteric artery (SMA) syndrome is a gastrovascular disorder in which the third and final portion of the duodenum is compressed between the abdominal aorta (AA) and the overlying SMA. Our case presents an 11-year-old female with chronic intermittent vomiting that started since she was 6 months old. Contrast enhanced computed tomography sc...
Superior mesenteric artery (SMA) syndrome often occurs in the setting of rapid weight loss and scoliosis corrective spinal surgery. A reduction of fat around the third part of the duodenum can predispose the duodenum to compression and obstruction by the SMA as it emerges from the abdominal aorta. In this report, we describe this underdiagnosed con...
Superior mesenteric artery (SMA) syndrome is a rare clinical entity characterized by the compression of third part of the duodenum between the superior mesenteric artery and abdominal aorta due to loss of intervening mesenteric fat pad. This article reports a case of a patient operated for tubercular intestinal perforation following which she devel...
Citations
... В норме угол между аортой и отходящей от нее верхней брыжеечной артерией составляет 25-60°. Диагностические критерии синдрома: аорто-мезентериальный угол менее 20°, аортомезентериальное расстояние менее 8 мм, а также расширение желудка и проксимальных отделов двенадцатиперстной кишки [9]. ...
Background. Superior mesenteric artery syndrome is a rare pathological condition caused by an abnormal transposition of the superior mesenteric artery from the abdominal part of the aorta. It results in compression of the distal part of the duodenum between the aorta and the superior mesenteric artery. It is clinically manifested by signs of acute intestinal obstruction, including pain in the epigastric region, nausea, and profuse vomiting. In the absence of timely treatment, patients may experience electrolyte disturbance, severe nutritional deficiency, the risk of perforation of the stomach, aspiration pneumonia, bezoar formation, thromboembolism, and the development of other life-threatening complications that can lead to death. Case study. In the presented case study, superior mesenteric artery syndrome developed in a 17-year-old girl after surgical correction of a spinal deformity in the treatment of idiopathic scoliosis. This was due to postoperative loss of body weight, as well as a rapid change in the patients ratio of growth to body weight. Discussion. Significant clinical improvement was achieved as a result of an integrated approach to the treatment of this complication. However, despite the successful result from conservative therapy, the patient remains at risk of developing chronic duodenal obstruction of varying severity, which may require surgical treatment. Conclusion. With the untimely and incomplete treatment of superior mesenteric artery syndrome, the risk of developing chronic intestinal obstruction increases. Treatment of this complication begins with conservative therapy. In the absence of the effect of conservative therapy, and in the case of disease progression, the development of life-threatening conditions (such as bleeding and perforation) requires surgical treatment.
Background:
Superior mesenteric artery (SMA) syndrome is a well-recognized, rare complication of undergoing surgical correction of a spinal deformity. The objective of this study was to summarize the best available evidence on SMA syndrome treatment after scoliosis surgery. To identify differences, special attention was paid to scoliosis pathology, intervention and SMA syndrome presentation.
Methods:
A systematic review of the literature was performed on SMA syndrome following scoliosis surgery. The Web of Science, PubMed, Wanfang (Chinese) and EMBASE databases were systematically searched for articles from January 1971 to October 2020. The main subjects discussed are scoliosis pathology, intervention and SMA syndrome presentation.
Results:
A total of 32 articles with 52 cases were included in our report. The mean age of patients with SMA syndrome following scoliosis surgery was 14.7 ± 2.9 years and the majority (n=42, 80.8%) were girls. The most frequently reported scoliosis type was adolescent idiopathic scoliosis (n=34, 65.4%). The mean postoperative days (POD) (interval between the surgical treatment and the onset of symptoms) was 9.6 ± 9.5 days. Different treatment methods were analyzed in 46 patients. We noted a trend toward a higher percentage of patients with POD<48 h in the group with surgical treatment than in the conservative treatment group (P= 0.002).
Conclusion:
In summary, in this systematic review, for the first time, we found that the time of onset of postoperative symptoms can be used as an important reference index for surgical intervention. We also believe that recommendations about the treatment of SMA syndrome following scoliosis surgery should include this finding. Given the lack of robust clinical evidence, these findings warrant verification in a prospective multicenter screening trial.
Vascular complications in spine surgery are rare but potentially devastating events. They may occur during surgery in the cervical, thoracic, and lumbo-sacral regions of the spine, and all operative approaches present at least some risk. Some complications are highly specific to various approaches and/or procedures. Meticulous surgical technique, careful preoperative planning, and familiarity with normal and anomalous vascular anatomy may minimize the risk of complications. Spine surgeons should be knowledgeable regarding specific and general vascular complications as early recognition and timely treatment may prevent poor patient outcomes.
