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Superior Mesenteric Artery Syndrome
Superior Mesenteric Artery Syndrome Alberto Valdes, MD, FACS, Oscar Cárdenas, MD, Adriana Espinosa, MD, Oscar Villazón, MD, FACS, Viridiana Valdes, ACP, Hospital Angeles Lomas, Estado de México, México
0.2% and 1% in diverse radiologic studies.5,6 It is more frequent in young anorexic women between 10 and 40 years of age, ICU trauma patients, drug addicts, and after orthopaedic spinal column surgery. The method of duodenojejunostomy described by Lee and Mangla has better results than other techniques.7
A 22-year-old woman presented with a 6-month history of weight loss, postprandial epigastric colic, nausea, and vomiting. A double contrast gastric-duodenum x-ray showed duodenal dilatation and stenosis (A). A flexible endoscopy revealed duodenal obstruction, gastric retention, and erosive esophagitis. A diagnosis of superior mesenteric artery syndrome (SMAS) was made. We performed a laparotomy, making a latero-lateral duodenojejunoanastomosis (B, C). She had a satisfactory outcome and was discharged without complications. Recognized as Wilkie disease or duodenal arterial mesenteric compression, SMAS was described 100 years ago by Rokitansky.1,2 Comparing patients and cadavers, the angle projection of the mesenteric artery from the aorta seems to be stretched and cause occlusion.3 The fat around the mesenteric artery improves the angle, so weight loss leads to the symptoms. Another theory proposes alteration in intestinal motility, but this is not confirmed.4 The most suitable method of diagnosis is x-ray contrast studies to observe the duodenal dilatation and gastric retention. Other authors use CT scan, MRI, or flexible endoscopy. SMAS is an infrequent pathology finding: between
© 2005 by the American College of Surgeons Published by Elsevier Inc.
REFERENCES 1. Nyhus LM, Baker RJ, eds. Mastery of surgery. 2nd ed. Little Brown; 1992:764–772. 2. Waseem M, Salvatore C. Abdominal pain: an uncommon cause. Pediatr Emerg Care 2004;20:531–553. 3. Diwakaran HH, Stolar CG, Prather CM. Superior mesenteric artery syndrome. Gastroenterology 2001;121:516, 746. 4. Bascietto C, Borrelli O, Roggini M, et al. Gastrointestinal motility is not involved in the superior mesenteric artery syndrome: report of four cases. J Pediatr Gastroenterol Nutr 2004;39:S440. 5. Garcı´a J, Pérez A, Sanchez R, et al. Sı´ndrome de la arteria mesentérica superior. Cir Gen 2000;22:347–350. 6. Sanchez-Lozada R, Acosta-Rosero AU, Balas-Salame C, et al. Sı´ndrome de la arteria mesentérica superior como causa de intolerancia parcial crónica a la alimentación oral. Reporte de un caso y revisión del tema. Rev Gastroenterol Mex 2002;67:38–42. 7. Lee CS, Mangla JC. Superior mesenteric artery compression syndrome. Am J Gastroenterol 1978;70:141–150.
808
ISSN 1072-7515/05/$30.00 doi:10.1016/j.jamcollsurg.2005.04.033
0.2% and 1% in diverse radiologic studies.5,6 It is more frequent in young anorexic women between 10 and 40 years of age, ICU trauma patients, drug addicts, and after orthopaedic spinal column surgery. The method of duodenojejunostomy described by Lee and Mangla has better results than other techniques.7
A 22-year-old woman presented with a 6-month history of weight loss, postprandial epigastric colic, nausea, and vomiting. A double contrast gastric-duodenum x-ray showed duodenal dilatation and stenosis (A). A flexible endoscopy revealed duodenal obstruction, gastric retention, and erosive esophagitis. A diagnosis of superior mesenteric artery syndrome (SMAS) was made. We performed a laparotomy, making a latero-lateral duodenojejunoanastomosis (B, C). She had a satisfactory outcome and was discharged without complications. Recognized as Wilkie disease or duodenal arterial mesenteric compression, SMAS was described 100 years ago by Rokitansky.1,2 Comparing patients and cadavers, the angle projection of the mesenteric artery from the aorta seems to be stretched and cause occlusion.3 The fat around the mesenteric artery improves the angle, so weight loss leads to the symptoms. Another theory proposes alteration in intestinal motility, but this is not confirmed.4 The most suitable method of diagnosis is x-ray contrast studies to observe the duodenal dilatation and gastric retention. Other authors use CT scan, MRI, or flexible endoscopy. SMAS is an infrequent pathology finding: between
© 2005 by the American College of Surgeons Published by Elsevier Inc.
REFERENCES 1. Nyhus LM, Baker RJ, eds. Mastery of surgery. 2nd ed. Little Brown; 1992:764–772. 2. Waseem M, Salvatore C. Abdominal pain: an uncommon cause. Pediatr Emerg Care 2004;20:531–553. 3. Diwakaran HH, Stolar CG, Prather CM. Superior mesenteric artery syndrome. Gastroenterology 2001;121:516, 746. 4. Bascietto C, Borrelli O, Roggini M, et al. Gastrointestinal motility is not involved in the superior mesenteric artery syndrome: report of four cases. J Pediatr Gastroenterol Nutr 2004;39:S440. 5. Garcı´a J, Pérez A, Sanchez R, et al. Sı´ndrome de la arteria mesentérica superior. Cir Gen 2000;22:347–350. 6. Sanchez-Lozada R, Acosta-Rosero AU, Balas-Salame C, et al. Sı´ndrome de la arteria mesentérica superior como causa de intolerancia parcial crónica a la alimentación oral. Reporte de un caso y revisión del tema. Rev Gastroenterol Mex 2002;67:38–42. 7. Lee CS, Mangla JC. Superior mesenteric artery compression syndrome. Am J Gastroenterol 1978;70:141–150.
808
ISSN 1072-7515/05/$30.00 doi:10.1016/j.jamcollsurg.2005.04.033