Superior Mesenteric Artery Syndrome

What is Superior Mesenteric Artery Syndrome?

Wilkie syndrome or the Superior mesenteric artery syndrome, abbreviated as SMAS, is a rare type of disorder that mainly affects the digestive system. This problem is most commonly observed in women than men. The superior mesenteric artery is the blood vessel that supplies blood to the cecum, colon, and small intestine.

This disorder causes the superior mesenteric artery to curve in an angular position which causes the duodenum to be compressed in between two arteries; the superior mesenteric artery and the aorta. The compression results to a complete or partial obstruction of the duodenum that leads to the development of symptoms.

Loss of fatty tissue that results to various types of enervating conditions is believed to be the originating factor of the acute angulation and these conditions could be; anorexia nervosa, cardiac cachexia, malabsorption, or hypercatabolic states.

Some individuals who are in the earlier stages of superior mesenteric syndrome are mostly unaware that they have the condition until major damage to health is made, since they often attempt to adjust to the condition by merely changing into a more digestible diet or decreasing their food intake from time to time.

Signs and Symptoms of Superior Mesenteric Artery Syndrome

Individuals with superior mesenteric artery syndrome usually experience symptoms like bloating after each meal, early abdominal fullness, nausea, vomiting of some food and the extreme pain in the abdomen after eating a meal due to the compression.

Other symptoms include:

• Abdominal distortion
• Belching
• Diarrhea
• Tenderness on the area of the abdomen
• Reflux
• Heartburn
• Feeding problems
• Acute malnutrition in some individuals
• Poor weight gain

Superior mesenteric artery syndrome can exist in two types; acute and chronic. Individuals with the chronic form tend to develop “food fear” and have a long history of abdominal complaints depending on the compression. The acute form of this syndrome develops right away after traumatic incidents that force the superior mesenteric artery to hyper-extend across the duodenum. Factors that might contribute to the syndrome are; loss of tone in the abdominal muscles, lengthened bed rest, use of body casts, lordosis, and previous surgery in the abdomen.

Superior Mesenteric Artery Syndrome Diagnosis

Diagnostic techniques done for SMAS can be very hard and tricky. The syndrome may be imitated or caused by an eating disorder and having to distinguish the two from each other is very important since misdiagnosis can be really dangerous. The diagnosis is done based on the radiologic evidence of blockage and clinical symptoms. SMA syndrome is only considered after a patient had undergone a thorough evaluation of their gastrointestinal tract.

A diagnosis can be confirmed by:

• Upper Gastrointestinal Series – This contains a set of x-rays for the examination of the stomach, esophagus, and small intestine.
• Hypotonic Duodenography – This type of procedure still uses an x-ray to visualize images of the duodenum.
• Computed Tomography Scan – This scan can show the compression of the duodenum by the aorta and the superior mesenteric artery.

Treatment for Patients with SMAS

Treatments for superior mesenteric artery syndrome usually focuses on undertaking the primary cause of the condition that composes of finding a resolution of the present conditions and for the patient to gain weight.

At least 70% of patients who experience either the acute or chronic form of the syndrome are commonly cured with medical treatment, while the others must undergo a surgical treatment.

Medical treatment is always the first choice in all cases, except for those patients who require emergency surgery upon presentation. Symptoms usually improve after the patient restores enough weight, except when reversed peristalsis presents, or if the fats gained decline to gather within the mesenteric angle.

Individuals mostly benefits from overnutrition despite any disease history. Medical treatments involve nasogastric tube decompression wherein a tube is inserted through the nose into the stomach, and proper positioning after eating a meal such as the left lateral decubitus or prone position.

For severe cases, a feeding tube might be needed to supplement enough calories before slowly introducing to oral liquids and other soft and solid foods. If none of the other treatment strategies work, surgery is the last resort. Nevertheless, other treatment options should be done first for at least 4-6 weeks before taking surgery into consideration.

References:
1. https://rarediseases.info.nih.gov/gard/7712/superior-mesenteric-artery-syndrome/resources/8
2. http://www.iffgd.org/site/gi-disorders/other/sma-syndrome
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490234/
4. Magee, G.; Slater, B. J.; Lee, J. T.; Poultsides, G. A. (2011). “Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome”. Digestive Diseases and Sciences 56 (9): 2528–2531.
5. Watanabe, T. (2011). “Superior mesenteric artery syndrome and acute pancreatitis in a boy with eating disorder: A case report”. Open Journal of Pediatrics 1 (4): 94–97.
Barsoum, M. K.; Shepherd, R. F.; Welch, T. J. (2008). “Patient with both wilkie syndrome and nutcracker syndrome”. Vascular Medicine 13 (3): 247–250.