Superior mesenteric artery syndrome (SMAS),case report with litrature review

Asem Ghasoup, MD, FACS, MRCPS, Turki Al Qurashi, MD, Mohammed Widenly, MD, MRCS, Marwan Abu Farah. security forces hospital-Makkah

Index Word: Superior Mesenteric artery, Aorto-mesenteric angle, Duodenojejunal anastomosis.

Superior mesenteric artery syndrome (SMAS), first described by Rokitanskini in 1861, superior mesenteric artery normally forms an angle of approximately 45° between Abdominal aorta and third part of duodenum passing through this angle. In SMAS, the Patients have a narrow aortomesenteric angle in the range of 6° to 11° (mean =8°) leading to high intestinal obstruction.

The diagnosis of SMAS is always by exclusion of all possible common causes. Epigastric fullness, post prandial pain, voluminous bilious vomiting, and weight loss are the most common symptoms. These symptoms are due to compression of the third part of the duodenum against the posterior structures by a narrow angled SMA. Surgery is always indicated if the non-surgical management fails.

We report one case of SMA syndrome in 15 years old female who presented with epigastric pain, bilious vomiting and rapid weight loss resulting in severe duodenal compression that necessitated surgical treatment, patient underwent laparoscopic duodenojejunal bypass surgery to relieve the symptoms.

Conclusion:

Superior mesenteric artery syndrome (SMAS) is a rare condition caused by compression of the transverse portion of the duodenum between the superior mesenteric artery (SMA) and the aorta. Symptoms are non-specific and the diagnosis depends on high index of suspicion. This condition can be diagnosed by CT scan and it is an acceptable method for diagnosis and can be replace the arteriogram in confirming the diagnosis. Conservative management may be sufficient in early cases. Laparoscopic Duodenojejunostomy is the surgical treatment of choice

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