No abstract available.
Mesenteric Artery, Superior* ; Superior Mesenteric Artery Syndrome*

Introduction: Superior mesenteric artery (SMA) syndrome is a rare and unusual acquired cause of functional duodenal obstruction whose diagnosis can be easily missed without knowledge of this condition. Case Presentation: We report a case of a 27-year-old female, presenting with post-prandial vomiting, early satiety, bloatedness and weight loss for about 10 months. Vital signs were stable. She was grossly underweight with a BMI of 11.72 kg/m2 (height=1.6m, weight=30kg). Physical examination was unremarkable. Gastrointestinal series revealed a narrowing in the third portion of the duodenum likely secondary to extrinsic compression. Contrast-enhanced CT scan of the whole abdomen was performed with 3D reconstruction. There were no definite signs of gastrointestinal obstruction. However, a narrow/acute aorto-mesenteric angle of 13 degrees compressing the third part of the duodenum was noted. Superior mesenteric syndrome was considered, prompting further work-up. Primary hyperthyroidism was the root cause of the patient’s weight loss that lead to this condition. Patient was given nutritional support, parenterally and enterally. She was discharged improved after oral feeding was tolerated and patient started to gain weight. Discussion: Superior mesenteric artery (SMA) syndrome is an uncommon medical condition brought about by a decrease in the aortomesenteric angle from the usual 45o to less than 15o resulting in vascular compression of the third part of the duodenum leading to gastrointestinal obstruction. A high index of suspicion is needed to prevent the diagnosis from being missed which may in turn lead to unnecessary testing and treatment. If recognized early, the condition may be managed conservatively. Surgical management is only required when conservative methods fail. Conclusion Early recognition and a thorough evaluation is therefore imperative so conservative measures can be maximized at the outset.
Superior Mesenteric Artery Syndrome

Bariatric surgery is the most effective and durable treatment for morbidly obese patients. However, there are remained unsolved problems with various types of complications. Superior mesenteric artery syndrome is a rarely known condition occurred following bariatric surgery. We experienced 54-year-old female patient diagnosed with superior mesenteric artery syndrome 5 year later after laparoscopic adjustable gastric banding. Because symptoms have not improved with conservative care, laparoscopic duodenojejunal bypass was successfully performed for this patient.
Bariatric Surgery ; Female ; Humans ; Mesenteric Artery, Superior ; Middle Aged ; Superior Mesenteric Artery Syndrome

Acupuncture Therapy ; Adolescent ; Humans ; Male ; Superior Mesenteric Artery Syndrome ; therapy

No abstract available.
Intestinal Obstruction ; Lung ; Lung Neoplasms ; Superior Mesenteric Artery Syndrome

Superior mesenteric artery syndrome is a rare clinical disease in Korea. The authors experienced three cases of the superior mesenteric artery syndrome. All of patients complained of continuos bilious vomiting, epigastric discomfort, epigastric fullness, and weight loss. The superior mesenteric artery syndrome was diagnosed preoperative, by using physical examination, gastrofiberscopy, upper gastrointestinal series, abdominal computerized tomography (CT), and spiral CT angiogram. We performed a Roux-en-Y duodenojejunostomy. We measured the angle between the aorta and that superior mesenteric artery by using a spiral CT angiogram. The angles were 10o, 11o, and 11o. Postoperatively they were improved. A spiral CT angiogram was a noninvasive method of diagnosing the superior mesenteric artery syndrome compared with a femoral angiography. The Roux-en-Y duodenojejunostomy was the proper method of treatment for the superior mesenteric artery syndrome.
Angiography ; Aorta ; Humans ; Korea ; Mesenteric Artery, Superior* ; Physical Examination ; Superior Mesenteric Artery Syndrome* ; Tomography, Spiral Computed ; Vomiting ; Weight Loss

STUDY DESIGN: Retrospective study. PURPOSE: To more accurately determine the incidence and clarify risk factors. OVERVIEW OF LITERATURE: Superior mesenteric artery syndrome is one of the possible complications following correctional operation for scoliosis. However, when preliminary symptoms are vague, the diagnosis of superior mesenteric artery syndrome may be easily missed. METHODS: We conducted a retrospective study using clinical data from 118 patients (43 men and 75 women) who underwent correctional operations for scoliosis between September 2001 and August 2007. The mean patient age was 15.9 years (range 9~24 years). The risk factors under scrutiny were the patient body mass index (BMI), change in Cobb's angle, and trunk length. RESULTS: The incidence of subjects confirmed to have obstruction was 2.5%. However, the rate increased to 7.6% with the inclusion of the 6 subjects who only showed clinical symptoms of obstruction without confirmative study. The BMI for the asymptomatic and symptomatic groups were 18.4+/-3.4 and 14.6+/-3, respectively. The change in Cobb's angle for the asymptomatic and symptomatic groups were 24.8+/-13.6degrees and 23.4+/-9.1degrees, respectively. The change in trunk length for the asymptomatic and symptomatic groups were 2.3+/-2.1 cm and 4.5+/-4.8 cm, respectively. Differences in Cobb's angle and the change in trunk length between the two groups did not reach statistical significance, although there was a greater increase in trunk length for the symptomatic group than for the asymptomatic group. CONCLUSIONS: Our study shows that the incidence of superior mesenteric artery syndrome may be greater than the previously accepted rate of 4.7%. Therefore, in the face of any early signs or symptoms of superior mesenteric artery syndrome, prompt recognition and treatment are necessary.
Body Mass Index ; Humans ; Incidence ; Male ; Mesenteric Artery, Superior ; Retrospective Studies ; Risk Factors ; Scoliosis ; Superior Mesenteric Artery Syndrome

Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by a decreased aortomesenteric angle that causes a duodenal obstruction. Various medical and psychiatric conditions may result in the initial rapid weight loss that causes narrowing of the aortomesenteric angle. Isolated dissection of the superior mesenteric artery (DSMA) is an uncommon cause of acute mesenteric ischemia. Several literature reports suggest that medical treatment in combination with close observation is reasonable in uncomplicated dissection with stable hemodynamic status. Recently, as several reports describe, rapid revascularization by percutaneous angioplasty and endovascular stent insertion can prevent bowel ischemia that progresses to irreversible bowel necrosis. However, the stability of endovascular stents at the DSMA has not been confirmed, because its use is reasonably infrequent. Here, we report a case of SMA syndrome, as a complication of endovascular stent placement at the DSMA.
Angioplasty ; Duodenal Obstruction ; Hemodynamics ; Ischemia ; Mesenteric Artery, Superior ; Necrosis ; Stents ; Superior Mesenteric Artery Syndrome ; Vascular Diseases ; Weight Loss

The most common cause of small bowel obstruction is postoperative adhesion, and besides a hernia, metastatic or primary cancer and small bowel tumors are possible causes. Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction and is associated with debilitating conditions with marked weight loss. SMA syndrome results from the compression of the third part of the duodenum due to the narrowing of the aortomesenteric angle. We report a 28-year-old woman with SMA syndrome after acute gastroenteritis. Her stomach was severely dilated due to the duodenal obstruction and computed tomography showed the compression of the third portion of the duodenum by SMA. She was conservatively cared for and thus favorably improved.
Adult ; Duodenal Obstruction ; Duodenum ; Female ; Gastroenteritis ; Hernia ; Humans ; Mesenteric Artery, Superior ; Stomach ; Superior Mesenteric Artery Syndrome ; Weight Loss

Superior mesenteric artery (SMA) syndrome is a symptom complex resulting from compression of third portion of duodenum by the root of the small bowel mesentery at the level of the SMA. This syndrome can occur as an acute illness but more commonly it appears as chronic condition. Identification of this syndrome can be a diagnostic dilemma and it is frequently made by exclusion. In our patient, rapid weight loss, nausea and bile stained vomiting were present. Ultrasound and MR-angiography were performed for measuring the angle and the distance between the SMA and the aorta. We confirmed the diagnosis via the reduced aorto-mesenteric angle and distance and the patient was then treated by laparoscopic surgery. After lysis of the ligament of Treitz, the patient's symptom were improved. This syndrome must be considered as one of the causes of upper gastrointestinal obstruction.
Aorta ; Bile ; Diagnosis ; Duodenum ; Humans ; Laparoscopy* ; Ligaments ; Mesenteric Artery, Superior* ; Mesentery ; Nausea ; Superior Mesenteric Artery Syndrome* ; Ultrasonography ; Vomiting ; Weight Loss