Small Intestine: Superior Mesenteric Artery (SMA) Syndrome

Superior Mesenteric Artery (SMA) Syndrome

Also Known As

  • Wilkie Syndrome
  • Arteriomesenteric Duodenal Obstruction
  • Cast Syndrome – Specifically if Occurs After Corrective Surgery for Scoliosis

Pathophysiology

  • Obstruction of the Third Portion of the Duodenum Between the SMA & Aorta
    • Normal Aortomesenteric Angle 38-65 Degrees
    • Sharp Aortomesenteric Angle Primarily from Loss of the Mesenteric Root Fat Pad
  • Causes:
    • Profound Weight Loss (Most Common)
      • Severe Illness (Cancer, AIDS, Burs or Trauma)
      • Bariatric Surgery
      • Paraplegia
      • Drug Abuse
      • Anorexia
    • Corrective Surgery for Scoliosis – Lengthens Spine & Displaces SMA
    • Congenitally Short Ligament of Treitz (Rare)

Presentation

  • Nonspecific Signs of Obstruction
  • Symptoms May be Relieved by Positioning to Decrease Compression
    • Positions: Prone, Left Lateral Decubitus or Knees-to-Chest

Diagnosis

  • Diagnosis of Exclusion
  • General Imaging: CT or UGI

Treatment

    • Primary Tx: High Calorie Diet
    • If Fails: Surgery
    • Surgical Options:
      • Duodenojejunostomy (Preferred with Best Results)
      • Gastrojejunostomy
      • Strong’s Procedure – Division of the Ligament of Treitz with Duodenum Laying to the Right of the SMA

SMA Syndrome 1

SMA Syndrome CT 2

SMA Syndrome UGI 1

Strong’s Procedure 1

References

  1. Pillay Y. Superior Mesenteric Artery Syndrome: A Case Report of Two Surgical Options, Duodenal Derotation and Duodenojejunostomy. Case Rep Vasc Med. 2016;2016:8301025. (License: CC BY-4.0)
  2. Clapp B, Applebaum B. Superior mesenteric artery syndrome after Roux-en-y gastric bypass. JSLS. 2010 Jan-Mar;14(1):143-6. (License: CC BY-NC-ND-3.0)