Superior mesenteric artery syndrome
- Vascular compression of the duodenum
- Wilkie syndrome
- Cast syndrome
- Arteriomesenteric duodenal compression syndrome
Treatment for superior mesenteric artery syndrome typically focuses on addressing the underlying cause of the condition. For example, symptoms often improve after lost weight is restored or a body cast is removed. Nasogastric decompression (a tube passed through the nose into the stomach) and proper positioning after eating (such as lying in the left side or standing or sitting with a knee-to-chest position) may be recommended to alleviate symptoms.
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 to avoid vomiting 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.
Surgery options are:
- Strong’s procedure: Where the duodenum is re-positioned to the right of the superior mesenteric artery
- Gastrojejunostomy: Where the jejune (the part of the intestines that continues with the duodenum) is foined directly to the stomach
- Duodenojejunostomy with or without division or resection of the fourth part of the duodenum.
- Karrer FM. Superior Mesenteric Artery Syndrome. Medscape Reference. July 2015; 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.
- Scovell S & Hamdan A. Superior Mesenteric Artery Syndrome. UpToDate. Waltham, MA: UpToDate; June 22, 2015; http://www.uptodate.com/contents/superior-mesenteric-artery-syndrome.