Superior mesenteric artery syndrome (with video) - 23/08/11
Doi : 10.1016/j.gie.2007.08.009
| Commentary SMA syndrome was described in 1861 by Rokitansky, who also proposed that its cause was obstruction of the third part of the duodenum as a result of arteriomesenteric compression. Such compression often follows rapid weight loss and occurs when the angle between the SMA and aorta is narrowed to less than 25 degrees, thereby entrapping the duodenum, which passes between the SMA and aorta. The SMA syndrome, also called the cast syndrome, is a well-known complication of scoliosis surgery; other contributing causes include high insertion of the duodenum into the retroperitoneum at the ligament of Treitz, and a low origin of the SMA. The SMA syndrome usually occurs in older children and adolescents, but in one series of 75 patients, two thirds of the cases involved women, with an average age of 41 years. Symptoms are those of a high intestinal obstruction and include postprandial epigastric pain, fullness, and vomiting. Symptoms may be relieved by lying on the left side, prone, or in the knee-chest position; conversely, they can be aggravated in the supine position. Pressure applied from below the umbilicus upward and toward the back (Hayes maneuver) is said to lift the SMA, thereby releasing the obstruction and relieving symptoms, although I have not found this to be the case. Albert Einstein taught us to regard old problems from a new angle, but here we have a new problem created by a new angle; the approach to both situations requires creative imagination. Therapy for SMA syndrome includes weight gain to increase the arteriomesenteric angle, but if conservative measures fail, duodenojejunostomy usually results in relief of symptoms. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 67 - N° 2
P. 348-350 - février 2008 Retour au numéro
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