Superior mesenteric artery syndrome
Other Names for this Disease
- Arteriomesenteric duodenal compression syndrome
- Cast syndrome
- Vascular compression of the duodenum
- Wilkie syndrome
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The superior mesenteric artery makes its way between two layers of the mesentery (membranous tissue which carries blood vessels and lymph glands and attaches organs to the abdominal wall) and crosses over the first part of the small intestine, called the duodenum. The duodenum is where partly digested foods from the stomach mix with bile from the gall bladder and digestive juices from the pancreas.
The signs and symptoms of superior mesenteric artery syndrome vary but may include:
- Abdominal fullness
- Bloating after meals
- Nausea and vomiting of partially digested food
- Mid-abdominal "crampy" pain that may be relieved by the prone or knee-chest position.
- prolonged bed rest
- rapid, severe weight loss
- rapid growth
- previous abdominal surgery
- use of body casts
- loss of tone in abdominal muscles
SMAS has also been reported to occur in some people with pancreatitis, peptic ulcers, and other inflammatory conditions of the abdomen. Rarely, the condition may be caused by an abnormality in the structure of the body (such as unusual position or location of the artery). Familial SMAS, recurrent SMAS, and idiopathic neonatal SMAS have also been reported.
In severe cases, intravenous (IV) nutritional support and/or a feeding tube may be needed to provide enough calories. Affected people can usually then be started on oral liquids, followed by slow and gradual introduction of small and frequent soft meals as tolerated. Then, regular solid foods may be introduced. Metoclopramide treatment may be beneficial for some people.
Surgery may be needed if other treatment strategies do not work. However, other treatment options should usually be tried for at least 4-6 weeks before considering surgery.
- Small Intestine. MedlinePlusMedical Encyclopedia. November 8, 2010; http://www.nlm.nih.gov/medlineplus/ency/imagepages/19221.htm. Accessed 7/26/2012.
- Duodenum. MedlinePlus Medical Encyclopedia. October 30, 2010; http://www.nlm.nih.gov/medlineplus/ency/article/002347.htm. Accessed 7/26/2012.
- Frederick Merrill Karrer, MD. Superior Mesenteric Artery Syndrome Clinical Presentation. Medscape Reference. October 2014; http://emedicine.medscape.com/article/932220-overview.
- Superior Mesenteric Artery (SMA) Syndrome. International Foundation for Functional Gastrointestinal Disorders. September 2014; http://www.iffgd.org/site/gi-disorders/other/sma-syndrome.