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2015 ; 2015
(ä): 628705
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Superior Mesenteric Artery Syndrome: Clinical and Radiological Considerations
#MMPMID26347903
Rabie ME
; Ogunbiyi O
; Al Qahtani AS
; Taha SB
; El Hadad A
; El Hakeem I
Surg Res Pract
2015[]; 2015
(ä): 628705
PMID26347903
show ga
Background. Superior mesenteric artery (SMA) syndrome is a rare condition of
duodenal obstruction, caused by the overlying SMA. Aim. To report on our
experience with the management of SMA syndrome, drawing the attention to its
existence. Material and Methods. We reviewed our records to identify cases
diagnosed with SMA syndrome, in the period from October 1995 to January 2012.
Results. Seven patients were identified, one male and six females. Their mean age
was 17.1 years. Vomiting and abdominal pain were the presenting complaints in all
patients and history of weight loss was present in six of them. In no patient was
the diagnosis suspected initially on clinical grounds. Only after radiological
investigations was the diagnosis declared. Radiology took the form of
gastrografin/barium meal only in four patients and both gastrografin/barium meal
and computerized tomography scan in the remaining three. Four patients responded
to medical treatment and surgery was performed in the remaining three, with open
duodenojejunostomy in two patients and laparoscopic dissection of the ligament of
Treitz in the third. Long lasting improvement was sustained in all patients
except one in the surgery group who, despite initial improvement, still has
infrequent attacks of abdominal pain. Conclusion. Although the clinical
manifestations of SMA syndrome are shared with many other disease entities, it
has unique radiological as well as endoscopic features, which enables a confident
diagnosis to be made. Once diagnosed, conservative treatment with nutritional
support and positioning should be tried first. In case of unresponsiveness,
surgery may give a lasting cure.