Superior mesenteric artery syndrome - 26/04/12
Doi : 10.1016/j.gie.2007.09.033
| Commentary The SMA arises from the abdominal aorta, usually at the level of L1, and descends at an acute angle into the mesentery. Normally, this angle is 25° to 60° and is maintained in part by the mesenteric fat pad that envelops the SMA. The duodenum typically crosses the aorta at the level of L3 and is suspended within this vascular angle by its attachment to the suspensory ligament of the duodenum, also called the ligament of Treitz. In SMA syndrome, the angle collapses, usually because of the loss of the fat pad, thereby scissoring the duodenum between the SMA and aorta. The cause of the weight loss is unimportant, and the syndrome has been observed in patients with malignancy, malabsorption, anorexia nervosa, and gastric bypass surgery, among other conditions. It also has been described after surgical correction of scoliosis, which lengthens the spine, displaces the SMA origin cephalad, and leads to an increase in the acuity of the aorto-SMA angle. Rarely, the ligament of Treitz is congenitally short and the duodenum is pulled up into the root of the angle. Patients may present acutely or insidiously with symptoms that are consistent with proximal small bowel obstruction, and that may be relieved by assuming the left lateral decubitus, prone, or knee-chest position. Diagnosis is by a variety of means, including upper GI series, CT, or magnetic resonance angiography, and even EUS, the latter enabling measurement of the aorta-SMA distance. Treatment involves correcting the proximate cause of the syndrome (eg, reversing the weight loss). Surgery is resorted to (eg, division of the ligament of Treitz, duodenojejunostomy) if conservative treatment fails. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
Vol 68 - N° 1
P. 152-153 - luglio 2008 Ritorno al numero
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