is superior mesenteric artery life threatening

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What is superior mesenteric artery (SMA) syndrome?

Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction. The defining feature of this syndrome is the compression of the third part of the duodenum between the SMA anteriorly and the aorta posteriorly leading to upper gastrointestinal obstruction.

What is a mesenteric aneurysm?

Mesenteric aneurysm: An enlargement of the superior mesenteric artery that may result in the blood vessel wall weakening and eventually rupture. Nutcracker syndrome: This syndrome occurs when the superior mesenteric artery and the aorta squeeze the left renal (kidney) vein. This vein carries filtered blood out of the kidneys.

What happens when the superior mesenteric artery is compressed?

This vein carries filtered blood out of the kidneys. The compression can lead to flank pain, blood in the urine or pelvic congestion. Superior mesenteric artery syndrome: This rare condition occurs when the superior mesenteric artery and the aorta squeeze the duodenum. The compression keeps food from leaving the stomach and pain when eating.

Where is the superior mesenteric artery in the small intestine?

Small intestine, including the duodenum (part that connects the small intestine to the stomach). Large intestine. Where is the superior mesenteric artery? The superior mesenteric artery is in the midsection of the digestive tract (midgut). It originates from the aorta between the celiac artery and renal arteries.

How serious is superior mesenteric artery syndrome?

Superior mesenteric artery syndrome is a rare cause of proximal small bowel obstruction and is linked to significant morbidity and mortality when the diagnosis is delayed.

Is superior mesenteric artery syndrome curable?

SMAS is a medically treatable cause of small bowel obstruction with an overall good prognosis. Conservative medical treatment with nutritional rehabilitation is the least risky of treatment options and is successful in the majority of patients.

What happens if superior mesenteric artery is blocked?

In mesenteric ischemia, a blockage in an artery cuts off blood flow to a portion of the intestine. Mesenteric ischemia (mez-un-TER-ik is-KEE-me-uh) occurs when narrowed or blocked arteries restrict blood flow to your small intestine. Decreased blood flow can permanently damage the small intestine.

What causes superior mesenteric artery syndrome?

Superior mesenteric artery syndrome results from the compression of the horizontal duodenum between the SMA and the aorta owing to atrophy of the mesenteric fat pad resulting from weight loss.

How long can you live with SMA syndrome?

Infants with type 1 SMA usually die before their second birthday. Children with type 2 or type 3 SMA may live full lives depending on the severity of symptoms. People who develop SMA during adulthood (type 4) often remain active and enjoy a normal life expectancy.

Can SMAS be fatal?

Delay in the diagnosis and treatment worsens the condition and can lead to a fatal outcome.

How do you fix superior mesenteric artery disease?

Treatment for SMA syndrome is largely medical and includes fluid resuscitation, total parenteral nutrition, passage of a nasoenteric tube past the obstruction for enteric feedings, small meals, and positional eating.

What does SMAS pain feel like?

This compression causes partial or complete blockage of the duodenum. Symptoms vary based on severity, but can be severely debilitating. Symptoms may include abdominal pain, fullness, nausea, vomiting, and/or weight loss.

How do you manage superior mesenteric arteries?

The first line of treatment for superior mesenteric artery syndrome is nonsurgical management that includes:Feeding through a catheter (parenteral nutrition)Gastric decompression (using a nasogastric tube)Electrolyte correction.Fluid resuscitation.Posture therapy.

Can you live with SMA syndrome?

What is SMA syndrome? Superior mesenteric artery (SMA) syndrome is a rare type of compression of the small intestine. It's a treatable condition, but a delayed diagnosis can lead to more severe symptoms or even death.

Can you recover from SMA syndrome?

Review of the orthopedic literature reveals that the success rate is 100% with medical management only in cases with an acute presentation of SMA syndrome.

Which body part of the patient is at risk for superior mesenteric artery syndrome?

The superior mesenteric artery syndrome (SMAS) is rare. However, it is a life threatening condition which occurs when the abdominal aorta and the superior mesenteric artery compress the distal part of the duodenum.

What organs does the superior mesentery artery supply?

The superior mesenteric artery supplies the midgut from the ampullary region of the second part of the duodenum to the splenic flexure of the large intestine. The inferior pancreaticoduodenal artery arises from the SMA and, along with the superior pancreaticoduodenal artery, supplies the head of the pancreas.

What major organs does the superior mesenteric artery supply?

The superior mesenteric artery provides blood to the pancreas and parts of the small intestine and large intestine. As a peripheral artery in the body's circulatory system, it has several branches that send blood to various parts of the GI tract.

What are the symptoms of a blocked artery in the stomach?

SymptomsSudden belly (abdominal) pain that may be mild, moderate or severe.An urgent need to have a bowel movement.Frequent, forceful bowel movements.Abdominal tenderness or bloating (distention)Blood in your stool.Nausea and vomiting.Mental confusion in older adults.

What happens when you have a blocked artery in your stomach?

When one or more of the mesenteric arteries narrow or become blocked, blood flow is restricted and the intestines fail to get enough oxygen. This is called ischemia - an inadequate blood supply (circulation) to an organ due to blockage of blood vessels in the area. Symptoms can include severe abdominal pain.

What is the management of superior mesenteric artery syndrome?

The diagnosis and management of superior mesenteric artery syndrome is with an interprofessional team that consists of a general surgeon, radiologist, emergency department physician, and a gastroenterologist. However, the majority of patients with this syndrome initially present to the nurse practitioner and primary care provider. Because the symptoms are non-specific and there is no sensitive test, the diagnosis in most cases is delayed.   Management in the acute setting includes fluid resuscitation, electrolyte correction, total parenteral nutrition and nasogastric tube insertion for gastric decompression. The patient should be educated on lifestyle changes such as eating small meals and adopt the left lateral decubitus position to improve symptoms. Most patients need a dietary consult as significant weight loss is common. Unfortunately, conservative measures help very few patients and most patients eventually require surgery. Various types of surgical procedures are done but none produces satisfactory results. Because there are very few cases, there are no large trials. Anecdotal reports indicate mild improvement in the short term but the long term prognosis remains unknown. The quality of life of these patients is poor. [11][12](Level V)

What causes duodenal compression?

Duodenal compression is usually due to the loss of the intervening mesenteric fat pad between the aorta and SMA, which in turn, results in a narrower angle between the vessels. The fat pad cushion functions to hold the SMA off the spine and protect it from duodenal compression. A normal aortomesenteric angle is 38 to 65 degrees; however, decreasing the angle less than 25 degrees will decrease the distance to less than 10 mm and cause compression to the third part of the duodenum. Decreases in the aortomesenteric angle can be either congenital or acquired. SMA syndrome is associated with significant weight loss including situations of hypermetabolism (trauma and burns) dietary conditions (anorexia nervosa and malabsorptive diseases) and cachexia causing conditions (AIDS, cancer, paraplegia). Other risk factors include surgical correction of scoliosis, congenitally short or hypertrophic ligament of Treitz, peritoneal adhesions, duodenal malrotation, Ladd's bands, abdominal aortic aneurysm, lumbar hyperlordosis, and mesenteric root neoplasm.

What is the name of the condition that occurs when the duodenum is compressed?

Superior mesenteric artery (SMA) syndrome is a rare disease defined as compression of the third portion of the duodenum between the abdominal aorta and the superior mesenteric artery. Other names for SMA syndrome have included chronic duodenal ileus, Wilkie syndrome, arterio-mesenteric duodenal compression syndrome and cast syndrome. The disease was first reported as a case report in 1842 by Carl Von Rokitansky, and in 1927, Wilkie further detailed the pathophysiology and diagnostic findings of the disease.

What is the treatment for AO angle?

The patient is encouraged to eat small meals and engage in posture therapy which involves patients lying in the left lateral decubitus position, rather than recombinant, to improve symptoms. Nutritional support through hyperalimentation is of great importance with conservative therapy in an attempt to increase the mesenteric fat pad, thus increasing the AO angle and improving symptoms. Many patients will fail conservative therapy and ultimately require surgical intervention.  Various surgical procedures have been considered for surgical management including gastrojejunostomy, Strong procedure (a division of the ligament of Treitz), transabdominal duodenojejunostomy and laparoscopic duodenojejunostomy. Traditional open bypass surgery was the standard of care until 1998 when the first successful laparoscopic duodenojejunostomy was performed. This technique has since surpassed open bypass as the most common surgical treatment. Laparoscopic duodenojejunostomy has recently replaced open bypass at the standard operative treatment. A study involving laparoscopic duodenojejunostomy as a treatment for failed conservative management was done on 12 patients. This retrospective study revealed improved or eliminated symptoms in 11 of the 12 patients without any postoperative bowel obstruction, wound infection, anastomotic complications or deaths. Most surgeons prefer duodenojejunostomy due to reported success rates of 80% to 100% with reduced postoperative pain shortened hospital stay and reduced risk of incisional herniation.

What is the diagnosis of SMA syndrome?

SMA syndrome presents with vague symptoms of bowel obstruction. However, diagnosis is based on interpreting clinical symptoms alongside radiological testing which can confirm its presence. Various imaging modalities that can be used include plain film x-ray, barium x-ray, endoscopy, computed tomography (CT), Doppler ultrasound, and magnetic resonance angiography (MRA). Plain radiographs may reveal a dilated stomach and diminished distal bowel gas. Endoscopy and barium studies can be used but are often nonspecific and not available in an emergency setting. Endoscopy, rather, can be used to investigate complications of the disease including gastric stasis, biliary reflux, gastritis and duodenal ulcers and to rule out other cause of the duodenal compression. CT scan is helpful in diagnostics in that it allows for measurement of aortomesenteric (AO) angle which aids in confirmation of SMA syndrome and has thus replaced MRA as the standard for diagnosis. The normal AO angle is between 38 to 65 degrees and has a distance of 10 to 28 mm. In a study which reviewed 8 cases of SMA syndrome, a reported AO angle cutoff of 22 degrees revealed a 42.8% sensitivity and 100% specificity, and a distance of 8 mm was both 100% sensitive and specific for the condition. Laboratory tests are usually nondiagnostic and it is noted that electrolyte disturbances as well as protein and albumin levels can still be normal despite associated weight loss. While it is rare, SMA syndrome is important to consider because the delay in diagnosis can result in significant morbidity and mortality from malnutrition, dehydration, electrolyte abnormalities, gastric pneumatosis and portal venous gas, gastrointestinal hemorrhage and gastric perforation. [8][9][10]

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What is the function of the superior mesenteric artery?

The superior mesenteric artery plays a vital role in keeping the digestive system healthy and functioning. If the artery clogs with plaque or develops a clot, blood flow to digestive organs slows. Rarely, the superior mesenteric artery presses against a renal vein or the duodenum, causing potentially life-threatening problems.

What is the superior artery?

Superior refers to the artery’s location above other arteries that supply the intestines. A related artery, the inferior mesenteric artery, supplies the lower gastrointestinal (GI) tract.

Which artery sends blood to the GI tract?

The superior mesenteric artery has several branches that send blood to various parts of the GI tract. The branches include the:

Which artery provides oxygenated blood and nutrients to the intestines?

The superior mesenteric artery provides oxygenated blood and nutrients to the intestines. These organs are part of the digestive system. The artery branches off of the aorta, which is the body’s largest blood vessel.

Where is the superior mesenteric artery located?

The superior mesenteric artery is in the midsection of the digestive tract (midgut). It originates from the aorta between the celiac artery and renal arteries. The celiac artery supplies blood to the liver, spleen and stomach. The renal arteries send blood to the kidneys.

Which artery provides blood to the pancreas and parts of the small intestine and large intestine?

The superior mesenteric artery provides blood to the pancreas and parts of the small intestine and large intestine. As a peripheral artery in the body’s circulatory system, it has several branches that send blood to various parts of the GI tract.

Which artery runs alongside the colon?

This provides the intestines with multiple pathways or sources of blood. The marginal artery of Drummond is one of these connections. This artery runs alongside the colon.

What is the SMA syndrome?

In SMA syndrome, the third portion of duodenum becomes tightly compressed between the SMA and the abdominal aorta. Normally, the presence of fat and lymphatic tissues around the SMA provides protection to the duodenum against compression. The protection of SMA is diminished among cachectic patients who have decreased fatty tissue around SMA resulting in angulation and reduction in the distance between the aorta and the SMA. [3], [4], [5] His weight was 3% percentile and height was 90–97% percentile. There was not sudden weight loss in his past medical history. His mother said that he has always been asthenic. The correlation between low fat tissue of our patient and this diagnosis was considered to be etiologically significant.

What is the cause of a gastrointestinal obstruction?

Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction. The defining feature of this syndrome is the compression of the third part of the duodenum between the SMA anteriorly and the aorta posteriorly leading to upper gastrointestinal obstruction. Marked weight loss, external compression of the abdomen, anatomic variation, and surgical alterations of anatomy have been described as causative factors in SMA syndrome.1 The most characteristic symptoms of SMA are post-prandial epigastric fullness with pain, eructation, and bilious vomiting. Acute gastric dilation, which is rarely seen, may result in several complications like dehydration, metabolic alkalosis, gastric necrosis and systemic circulatory failure.2 We think that this disease may be neglected by pediatricians because of the rare incidence among children. In this report; an adolescent boy with SMA syndrome showed gastric dilatation without any previous history and was treated conservatively to draw attention to this disease.

How long did a 17 year old vomit?

A 17-years-old boy was brought to our emergency department with complaints of vomiting and abdominal pain for the last 14 hours. He vomited almost 20 times during the day, he also had upper abdominal pain, which was gradually getting worse. He was moderately dehydrated, alert, normotensive (110/60 mmHg), and other vital signs were normal. His body weight and height were 55 kg and 185 cm, respectively. Although he had epigastric pain, other abdominal signs were normal; there were no signs of acute abdomen. Because he had moderate dehydration and persistent vomiting, intravenous fluid with isotonic saline, intravenous ondansetron and intravenous ranitidine were administered. After being consulted to the Pediatric Emergency Department, he was hospitalized. White blood cell count (7820/mm3), blood biochemistry including total amylase (57 U/L), CRP (0.4 mg/L, normal: <2.4 mg/L), and urinalysis were in normal ranges. Abdominal X-ray revealed a distended stomach reaching the spina iliaca level, and the walls of the stomach and duodenal bulb were widened with air-fluid levels in it. The presence of two air-fluid levels in the right upper quadrant was suggesting an obstruction in the stomach outflow and/or proximal duodenum ( Fig. 1 ). An abdominal computed tomography (CT) revealed the dilatation of distal esophagus, a prominent distention of the stomach that reaches the pelvis, a dilatation of the first three portions of duodenum –widest part 6 cm-, an obstructed third duodenal portion between SMA and abdominal aorta. Contrast enhanced CT revealed the presence of intramural air in the wall of the stomach and portal vein ( Fig. 2 ). The contrast study of upper gastrointestinal tract revealed the retarded transition of contrast from duodenum to jejunum on supine position and accelerated transition on prone position. The contrast was passed to jejunum in prone position. These clinical and radiological findings were compatible with SMA syndrome. The patient was treated conservatively with nasogastric (NG) decompression and intravenous hydration plus total parenteral nutrition without oral drinking and feeding. On the first day, 1100 ml gastric fluid was drained from the NG tube, 900 ml on the second day and 300 ml on the third day. The color of fluid was brown-dark green. His upper gastrointestinal endoscopic examination was performed on the fourth day; lower esophageal sphincter was seen loose on retroflexion, the large curvature was intensely hyperemic with many large ulcers, and the whole stomach seemed to be edematous. The duodenal bulb and distal parts of duodenum seemed normal, no ulcers or nodularity were noticed. The pathological evaluation revealed chronic superficial gastritis and foveolar hyperplasia. Ischemic finding, atrophy, intestinal metaplasia, lymphoid aggregates, and Helicobacter pylori were not detected by endoscopy.

What is superior mesenteric artery syndrome?

He had a 1-day history of nausea, vomiting, and abdominal pain, without chronic or recurrent symptoms. Diagnosis was established by abdominal plain x-ray, contrast enhanced abdominal computed tomography, and endoscopic examination. The patient was hospitalized, monitorized, and decompressed by nasogastric tube without oral feeding. The symptoms of the patient were gradually relieved by conservative treatment and he was discharged after one week. Clinicians should be careful when facing upper gastrointestinal symptoms that are resistant and non-responsive to treatment, and this syndrome should be kept in mind. This case is presented to draw attention to this disease because of its rare incidence.

Why do I vomit when I'm young?

The leading causes of vomiting during childhood are acute viral gastroenteritis, food poisoning and gastritis. [6], [7] Anti-emetic therapy and rehydration usually respond rapidly and well to vomiting in these diseases. In cases which do not respond to these medications, uncommon diseases including gastric pathologies, intestinal obstruction at any level of the gastrointestinal tract or acute pancreatitis usually come to mind. Acute and recurrent vomiting which is resistant to antiemetic and gastric drugs, plus upper abdominal pain and dehydration may be the signs of SMA. Emergency physicians should not overlook this diagnosis.

What is conservative treatment for NG decompression?

Treatment consisted of conservative measures such as NG decompression and hyperalimentation followed by oral feeding with frequent small meals. If conservative treatment fails, surgical treatment may be considered.10 Requirement of surgical treatment in particularly chronic cases is reported in literature. 10 Both clinical and radiological findings significantly improved after NG decompression in the presented patient. Our patient benefited from a conservative approach and did not need surgical treatment.

Is SMA a disease?

In conclusion, although vomiting and abdominal pain are frequently seen in minor gastrointestinal diseases including acute gastroenteritis or viral syndrome, less commonly seen diseases such as SMA syndrome should be remembered among patients resistant to medical therapy. In other words, SMA syndrome may present with acute symptoms, which may be misdiagnosed as gastroenteritis. Acute gastric dilatation is a life-threatening condition which must be immediately interfered with and treated.

What is the name of the condition where the duodenum is compressed?

Superior mesenteric artery syndrome (SMAS) is a digestive condition that occurs when the duodenum (the first part of the small intestine) is compressed between two arteries (the aorta and the superior mesenteric artery). This compression causes partial or complete blockage of the duodenum. [1] . Symptoms vary based on severity, ...

Why does SMAS occur?

Listen. SMAS typically is due to loss of the mesenteric fat pad (fatty tissue that surrounds the superior mesenteric artery). [3] . The superior mesenteric artery forms an angle with the abdominal aorta (due in part to the mesenteric fat pad), and part of the duodenum sits within this angled space. Anything that sharply narrows ...

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PubMed is a searchable database of medical literature and lists journal articles that discuss Superior mesenteric artery syndrome. Click on the link to view a sample search on this topic.

How to treat superior mesenteric artery syndrome?

[4] Nasogastric decompression (a tube passed through the nose into the stomach) and proper positioning after eating (such as lying in the left side or standing or sitting with a knee-to-chest position) may be recommended to alleviate symptoms. [1]

What tests are needed for SMAS?

[3] Tests that may be needed to evaluate a person with symptoms of SMAS include abdominal X-rays , upper GI series, ultrasound, arteriography, and computed tomography (CT scan).

What is support and advocacy?

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

What is the long term outlook?

The long-term outlook ( prognosis) can depend on whether the condition is diagnosed and treated in a timely manner. The prognosis may be excellent if it is diagnosed quickly and appropriate therapy is given. [1] . However, the condition may go unrecognized until a person experiences symptoms for a long time. [2] .

What is SMA syndrome?

SMA syndrome is also known as Wilkie's syndrome, cast syndrome, mesenteric root syndrome, chronic duodenal ileus and intermittent arterio-mesenteric occlusion. It is distinct from nutcracker syndrome, which is the entrapment of the left renal vein between the AA and the SMA, although it is possible to be diagnosed with both conditions.

What is the SMA angle?

Superior mesenteric artery ( SMA) syndrome is a gastro - vascular disorder in which the third and final portion of the duodenum is compressed between the abdominal aorta (AA) and the overlying superior mesenteric artery. This rare, potentially life-threatening syndrome is typically caused by an angle of 6°–25° between the AA and the SMA, in comparison to the normal range of 38°–56°, due to a lack of retroperitoneal and visceral fat ( mesenteric fat). In addition, the aortomesenteric distance is 2–8 millimeters, as opposed to the typical 10–20. However, a narrow SMA angle alone is not enough to make a diagnosis, because patients with a low BMI, most notably children, have been known to have a narrow SMA angle with no symptoms of SMA syndrome.

How to diagnose SMA?

Diagnosis may follow X-ray examination revealing duodenal dilation followed by abrupt constriction proximal to the overlying SMA, as well as a delay in transit of four to six hours through the gastroduodenal region. Standard diagnostic exams include abdominal and pelvic computed tomography (CT) scan with oral and IV contrast, upper gastrointestinal series (UGI), and, for equivocal cases, hypotonic duodenography. In addition, vascular imaging studies such as ultrasound and contrast angiography may be used to indicate increased bloodflow velocity through the SMA or a narrowed SMA angle.

What is the role of retroperitoneal fat and lymphatic tissue in the duodenum?

Retroperitoneal fat and lymphatic tissue normally serve as a cushion for the duodenum, protecting it from compression by the SMA. SMA syndrome is thus triggered by any condition involving an insubstantial cushion and narrow mesenteric angle. SMA syndrome can present in two forms: chronic/congenital or acute/induced.

What is the angle between the AA and SMA?

This rare, potentially life-threatening syndrome is typically caused by an angle of 6°–25° between the AA and the SMA, in comparison to the normal range of 38°–56°, due to a lack of retroperitoneal and visceral fat ( mesenteric fat). In addition, the aortomesenteric distance is 2–8 millimeters, as opposed to the typical 10–20.

What is the Hayes maneuver for SMA?

A Hayes maneuver, which corresponds to applying pressure below the umbilicus in cephalad and dorsal direction, elevates the root of the SMA, also slightly easing the constriction. Symptoms can be aggravated when leaning to the right or taking a face up position.

How far is the aortomesenteric distance?

In addition, the aortomesenteric distance is 2–8 millimeters, as opposed to the typical 10–20. However, a narrow SMA angle alone is not enough to make a diagnosis, because patients with a low BMI, most notably children, have been known to have a narrow SMA angle with no symptoms of SMA syndrome.

Signs and symptoms

• Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction. The defining feature of this syndrome is the compression of the third part of the duodenum between the SMA anteriorly and the aorta posteriorly leading to upper gastrointestinal obstruction. Marked weight loss, external compression of the abdomen, anato...

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