Korean J Med.
2013 Jan;84(1):28-36.
Superior Mesenteric Artery Syndrome: Past and Present
- Affiliations
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- 1Institution for Digestive Research, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea. iman0825@naver.com
Abstract
- Superior mesenteric artery syndrome (SMAS) is an uncommon disease resulting from compression of the third portion of the duodenum by the superior mesenteric artery. Typical symptoms of SMAS are anorexia, nausea, vomiting, early satiety, abdominal pain and postprandial fullness. The diagnosis requires radiologic studies in patients with symptoms suggestive of SMAS. Radiologic studies include upper gastrointestinal barium study, angiography, abdominal ultrasound, endoscopic ultrasound, computed tomography (CT), and magnetic resonance imaging. The SMA angle to the aorta is normally 45degrees (range, 38-56degrees), whereas in SMAS, that SMA angle is decreased to 6 to 25degrees. Additionally, the distance between the SMA and the aorta normally ranges from 10 to 20 mm, whereas in SMAS this distance is decreased to 2 to 8 mm. Recently SMAS diagnosis has been most commonly confirmed by CT. Therapy of SMAS includes weight gain to increase the aortomesenteric angle, but surgery is indicated in symptomatic patients when conservative management failed. To date, laparoscopic duodenojejunostomy seems to be a first-choice surgical options.
