J Korean Med Sci.  2013 Aug;28(8):1220-1225. 10.3346/jkms.2013.28.8.1220.

Optimal Duration of Medical Treatment in Superior Mesenteric Artery Syndrome in Children

• Shin MS
• Kim JY

• KMID: 1793029
• DOI: http://doi.org/10.3346/jkms.2013.28.8.1220

Abstract

The aim of this study was to investigate the outcome, and optimal duration of medical treatment in children with superior mesenteric artery syndrome (SMAS). Eighteen children with SMAS were retrospectively studied. The data reviewed included demographics, presenting symptoms, co-morbid conditions, clinical courses, nutritional status, treatments, and outcomes. The three most common symptoms were postprandial discomfort (67.7%), abdominal pain (61.1%), and early satiety (50%). The median duration of symptoms before diagnosis was 68 days. The most common co-morbid condition was weight loss (50%), followed by growth spurt (22.2%) and bile reflux gastropathy (16.7%). Body mass index (BMI) was normal in 72.2% of the patients. Medical management was successful in 13 patients (72.2%). The median duration of treatment was 45 days. Nine patients (50%) had good outcomes without recurrence, 5 patients (27.8%) had moderate outcomes, and 4 patients (22.2%) had poor outcomes. A time limit of >6 weeks for the duration of medical management tended to be associated with worse outcomes (P=0.018). SMAS often developed in patients with normal BMI or no weight loss. Medical treatment has a high success rate, and children with SMAS should be treated medically for at least 6 weeks before surgical treatment is considered.

Keyword

Superior Mesenteric Artery Syndrome; Medical Treatment, Outcome; Children

MeSH Terms

Adolescent
Bile Reflux/diagnosis
Child
Child, Preschool
Demography
Domperidone/therapeutic use
Dopamine Antagonists/therapeutic use
Drug Administration Schedule
Female
Histamine H2 Antagonists/therapeutic use
Humans
Infant
Male
Parenteral Nutrition
Retrospective Studies
Superior Mesenteric Artery Syndrome/*diagnosis/drug therapy
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Weight Loss
Dopamine Antagonists
Domperidone
Histamine H2 Antagonists

Figure

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  Fig. 1 Upper gastrointestinal series shows an abrupt cutoff of the third portion of the duodenum and dilatations of the first and second portions of the duodenum.

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  Fig. 2 Abdominal 3D CT scan shows gastric and proximal duodenal dilatations with compression of the third portion of the duodenum (arrows) between the superior mesenteric artery and the aorta. The aortomesenteric distance in this patient was 4 mm (A) and the aortomesenteric angle was 9.5° (B).

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