Superior mesenteric artery syndrome: Diagnosis and management

Abstract

Superior mesenteric artery (SMA) syndrome (also known as Wilkie's syndrome, cast syndrome, or aorto-mesenteric compass syndrome) is an obstruction of the duodenum caused by extrinsic compression between the SMA and the aorta. The median age of patients is 23 years old (range 0-91 years old) and predominant in females over males with a ratio of 3:2. The symptoms are variable, consisting of postprandial abdominal pain, nausea and vomiting, early satiety, anorexia, and weight loss and can mimic anorexia nervosa or functional dyspepsia. Because recurrent vomiting leads to aspiration pneumonia or respiratory depression via metabolic alkalosis, early diagnosis is required. The useful diagnostic modalities are computed tomography as a standard tool and ultrasonography, which has advantages in safety and capability of real-time assessments of SMA mobility and duodenum passage. The initial treatment is usually conservative, including postural change, gastroduodenal decompression, and nutrient management (success rates: 70%-80%). If conservative therapy fails, surgical treatment (i.e., laparoscopic duodenojejunostomy) is recommended (success rates: 80%-100%).

Keywords: Superior mesenteric artery syndrome; Wilkie’s syndrome; Cast syndrome; Aorto-mesenteric compass syndrome

Core Tip: To summarize, superior mesenteric artery syndrome (SMAS) is a rare condition that occurs when the superior mesenteric artery compresses the third part of the duodenum. This compression can cause obstructive symptoms and weight loss. SMAS can be caused by a variety of factors, including abnormal anatomy, rapid weight loss, and previous abdominal surgery. It is most commonly seen in young, thin females, but can occur in males and people of any age or body type. Treatment may involve dietary modifications, medications, and surgery to correct the underlying cause. If left untreated, SMAS can lead to serious complications, including malnutrition and intestinal damage.