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1.
J Pediatr Gastroenterol Nutr ; 79(3): 495-500, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38994677

ABSTRACT

OBJECTIVES: Both superior mesenteric artery syndrome (SMAS) and cannabinoid hyperemesis syndrome (CHS) may present with abdominal pain, nausea, and emesis - making them difficult to differentiate or determine when they co-occur in adolescents who regularly use cannabis. Here, we present nine cases of CHS co-occurring with SMAS and characterize their clinical courses. METHODS: Patients admitted at Children's Hospital of Colorado between January 1, 2015, and March 23, 2023, who had both cannabis use (F12.1-F12.99) and chronic vascular disorders of the intestine (K55.1) on their problem lists were identified from the electronic medical record using ICD 10 codes. Nine met criteria for SMAS and chronic cannabis use. RESULTS: Six of nine patients were female. The most common presenting symptoms were nausea (9), vomiting (9), and weight loss (9). Four patients received cannabis cessation support. Patients lost a mean of 6.0 kg, had an average body mass index (BMI) of 15.61 percentile (17.7 kg/m2) and BMI Z-scores of -1.5. Symptoms were present for a mean of 19.6 weeks before diagnosis. CONCLUSIONS: Adolescents who experience nausea, vomiting, abdominal pain, and weight loss in association with chronic cannabis use and/or SMAS can present with confusing and overlapping symptoms. Our cohort was described as having CHS with co-occurring SMAS on imaging. Although the etiology of weight loss cannot be definitively ascertained, we postulate that the recurring emetic attacks from CHS led to weight loss resulting in SMAS. Improvement in diagnostic criteria for this population as well as cannabis cessation programming may aid in deceasing morbidity from these co-occurring conditions.


Subject(s)
Superior Mesenteric Artery Syndrome , Vomiting , Humans , Female , Adolescent , Vomiting/etiology , Male , Superior Mesenteric Artery Syndrome/complications , Cannabinoids/adverse effects , Nausea/etiology , Marijuana Abuse/complications , Colorado/epidemiology , Syndrome , Child , Retrospective Studies , Abdominal Pain/etiology , Cannabinoid Hyperemesis Syndrome
2.
Cir Cir ; 92(3): 403-407, 2024.
Article in English | MEDLINE | ID: mdl-38862114

ABSTRACT

Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction which is characterized by compression of the duodenum due to narrowing of the space between the superior mesenteric artery and aorta. Incomplete duodenal obstruction due to SMAS in neonates is rarely reported in the literature. In this case, it is a full-term 2-day-old male with the complaint of recurrent vomiting starting soon after birth. The patient was diagnosed with SMAS and duodenoduodenostomy was performed. Accompanying Meckel's diverticulum was excised.


El síndrome de la arteria mesentérica superior (SMAS) es una causa rara de obstrucción duodenal que se caracteriza por la compresión del duodeno debido al estrechamiento del espacio entre la arteria mesentérica superior y la aorta. La obstrucción duodenal incompleta por SMAS en recién nacidos rara vez se informa en la literatura. En este caso se trata de un varón de 2 días nacido a término que presenta vómitos recurrentes desde poco después del nacimiento. El paciente fue diagnosticado de SMAS y se le realizó duodenoduodenostomía. Se extirpó el divertículo de Meckel que lo acompañaba.


Subject(s)
Duodenostomy , Meckel Diverticulum , Superior Mesenteric Artery Syndrome , Humans , Meckel Diverticulum/complications , Meckel Diverticulum/surgery , Superior Mesenteric Artery Syndrome/complications , Superior Mesenteric Artery Syndrome/surgery , Superior Mesenteric Artery Syndrome/diagnostic imaging , Male , Infant, Newborn , Duodenal Obstruction/etiology , Duodenal Obstruction/surgery , Vomiting/etiology
3.
Rev Gastroenterol Peru ; 44(1): 75-78, 2024.
Article in Spanish | MEDLINE | ID: mdl-38734916

ABSTRACT

Wilkie syndrome is a rare pathology that generates intestinal obstruction due to a decrease of the aortomesenteric angle compromising the third portion of the duodenum. We describe a case of an 18-year-old female patient, diagnosed with Wilkie syndrome, with clinical symptoms of intestinal obstruction and weight loss. The diagnosis was made with abdominal CT. Wilkie syndrome is a rare pathology, which becomes a diagnostic challenge because it presents a similar picture to other more common pathologies. We recommend that it should be suspected in the presence of duodenal obstruction.


Subject(s)
Superior Mesenteric Artery Syndrome , Humans , Female , Adolescent , Superior Mesenteric Artery Syndrome/diagnosis , Superior Mesenteric Artery Syndrome/complications , Intestinal Obstruction/etiology , Intestinal Obstruction/diagnosis , Duodenal Obstruction/etiology , Duodenal Obstruction/diagnosis , Tomography, X-Ray Computed
4.
BMJ Case Rep ; 17(2)2024 Feb 21.
Article in English | MEDLINE | ID: mdl-38383132

ABSTRACT

Superior mesenteric artery syndrome (SMAS) is a rare and potentially life-threatening cause of small bowel obstruction in which the superior mesenteric artery impinges on the third portion of the duodenum. SMAS is typically encountered in patients with low body fat and a history of rapid weight loss and is often diagnosed as a chronic or subacute condition. Here, we describe a case of a healthy adolescent boy without typical SMAS prodromal symptoms presenting with a severe, hyperacute proximal small bowel obstruction due to SMAS. Complications arising from massive gastric and duodenal distension, including gastric, pancreatic and renal ischaemia, necessitated emergent surgical intervention consisting of the duodenojejunostomy bypass with partial gastric resection. The patient recovered without significant lasting consequences.


Subject(s)
Intestinal Obstruction , Kidney Diseases , Superior Mesenteric Artery Syndrome , Male , Adolescent , Humans , Superior Mesenteric Artery Syndrome/complications , Superior Mesenteric Artery Syndrome/diagnosis , Superior Mesenteric Artery Syndrome/surgery , Duodenum/surgery , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Artery, Superior/surgery , Stomach , Intestinal Obstruction/complications , Ischemia/surgery , Ischemia/complications , Kidney Diseases/complications
5.
Nutrients ; 16(4)2024 Feb 16.
Article in English | MEDLINE | ID: mdl-38398865

ABSTRACT

BACKGROUND: Superior mesenteric artery syndrome (SMAS) is a rare condition caused by the compression of the duodenum, which may occur in the case of fast weight loss. Currently, the relationship between superior mesenteric artery syndrome and anorexia nervosa is still unclear. The aim of this study is to identify the precocious clinical signs and symptoms of SMAS in patients affected by anorexia nervosa so as not to delay the diagnosis. METHODS: We present the clinical case of a young female patient with anorexia nervosa complicated by SMAS. We performed a literature review of SMAS in children affected by anorexia nervosa between 1962 and 2023, according to the PRISMA Extension Guide for Scoping Reviews. RESULTS: Reviewing the literature, 11 clinical cases were described for the pediatric age. The median age at diagnosis was 17 years (ranging from 13 to 18 years). The diagnosis of SMAS may be challenging as symptoms overlap those of anorexia, but it should be kept in mind mostly in cases of post-prandial abdominal pain, anxiety or depression, nausea, vomiting, and weight loss. CONCLUSION: Even specific clinical symptoms may act as flag tags to drive attention to this rare but potentially fatal condition.


Subject(s)
Anorexia Nervosa , Superior Mesenteric Artery Syndrome , Humans , Female , Child , Adolescent , Superior Mesenteric Artery Syndrome/complications , Superior Mesenteric Artery Syndrome/diagnosis , Anorexia Nervosa/complications , Anorexia Nervosa/diagnosis , Duodenum , Abdominal Pain/etiology , Weight Loss
6.
World J Gastroenterol ; 30(5): 499-508, 2024 Feb 07.
Article in English | MEDLINE | ID: mdl-38414592

ABSTRACT

BACKGROUND: Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta (SMA-Ao). Although the left lateral recumbent position is considered effective in the treatment of SMA syndrome, individual variations in the optimal patient position have been noted. In this report, we present two elderly cases of SMA syndrome that exhibited rapid recovery due to ultrasonographic dynamic evaluation of the optimal position for each patient. CASE SUMMARY: Case 1: A 90-year-old man with nausea and vomiting. Following diagnosis of SMA syndrome by computed tomography (CT), ultrasonography (US) revealed the SMA-Ao distance in the supine position (4 mm), which slightly improved in the lateral position (5.7-7.0 mm) without the passage of duodenal contents. However, in the sitting position, the SMA-Ao distance was increased to 15 mm accompanied by improved content passage. Additionally, US indicated enhanced passage upon abdominal massage on the right side. By day 2, the patient could eat comfortably with the optimal position and massage. Case 2: An 87-year-old woman with vomiting. After the diagnosis of SMA syndrome and aspiration pneumonia by CT, dynamic US confirmed the optimal position (SMA-Ao distance was improved to 7 mm in forward-bent position, whereas it remained at 5 mm in the supine position). By day 7 when her pneumonia recovered, she could eat with the optimal position. CONCLUSION: The optimal position for SMA syndrome varies among individuals. Dynamic US appears to be a valuable tool in improving patient outcomes.


Subject(s)
Duodenal Obstruction , Superior Mesenteric Artery Syndrome , Humans , Male , Female , Aged , Aged, 80 and over , Superior Mesenteric Artery Syndrome/diagnostic imaging , Superior Mesenteric Artery Syndrome/therapy , Superior Mesenteric Artery Syndrome/complications , Duodenal Obstruction/diagnosis , Ultrasonography/adverse effects , Vomiting/diagnostic imaging , Vomiting/etiology , Tomography, X-Ray Computed/adverse effects , Mesenteric Artery, Superior/diagnostic imaging
8.
Am J Case Rep ; 24: e939420, 2023 Jul 09.
Article in English | MEDLINE | ID: mdl-37422696

ABSTRACT

BACKGROUND Food insecurity describes the lack of adequate and reliable access to food due to insufficient resources. The condition affects over one-quarter of the world's population and is exacerbated by factors such as conflicts, climate variability, rising costs of nutritious food, and economic slumps; these challenges are amplified by poverty and inequality. Food insecurity is associated with many negative health outcomes, such as iron deficiency anemia, poor oral health, and stunting of growth in children. CASE REPORT We present the case of a patient who had significant weight loss related to food insecurity then developed a rare adverse health outcome: superior mesenteric artery (SMA) syndrome. SMA syndrome is a condition in which reduction in the angle formed by the proximal SMA and aorta, most commonly from decreased mesenteric fat in the setting of significant weight loss, leads to compression of the third portion of the duodenum and resulting bowel obstruction. The patient underwent successful treatment with a novel approach: endoscopic placement of a gastrojejunostomy stent. CONCLUSIONS Food insecurity remains a wide-ranging public health issue that can have direct impact on the clinical outcomes of individuals. We describe SMA syndrome as a rare adverse outcome in a food insecure individual, adding to the growing list of health consequences associated with this condition. We also highlight endoscopic placement of a gastrojejunostomy stent as an emerging alternative to surgical treatment of SMA syndrome. The success of the procedure in this patient adds to the body of evidence supporting its efficacy and safety profile for this population.


Subject(s)
Gastric Bypass , Superior Mesenteric Artery Syndrome , Child , Humans , Superior Mesenteric Artery Syndrome/surgery , Superior Mesenteric Artery Syndrome/complications , Duodenum/surgery , Endoscopy , Stents
10.
Indian J Tuberc ; 69(4): 702-705, 2022 Oct.
Article in English | MEDLINE | ID: mdl-36460412

ABSTRACT

Superior Mesenteric Artery (SMA) Syndrome is a rare condition characterized by compression of the third part of the duodenum between the aorta and superior mesenteric artery due to decreased angle between these two vessels due to loss of intervening pad of fat. Tuberculosis is one of the causes, and its association with it is rare. However, SMA syndrome with significant gastrointestinal symptoms in TB poses a greater challenge in management, particularly in dissemination. Strong clinical suspicion, timely diagnosis and appropriate antituberculosis therapy are the keys to successful management.


Subject(s)
Superior Mesenteric Artery Syndrome , Tuberculosis, Miliary , Humans , Superior Mesenteric Artery Syndrome/complications , Superior Mesenteric Artery Syndrome/diagnosis , Antitubercular Agents/therapeutic use , Rare Diseases
14.
Rev. cir. (Impr.) ; 73(6): 744-747, dic. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1388890

ABSTRACT

Resumen Introducción: El síndrome de Wilkie es una causa poco frecuente de obstrucción del tracto digestivo superior, se caracteriza por una disminución del ángulo aorto-mesentérico que resulta en compresión de la tercera porción del duodeno que produce síntomas obstructivos altos. Caso Clínico: Presentamos el caso de una mujer de 64 años, con historia de dolor abdominal, pirosis, saciedad precoz e intolerancia a la vía oral, en quien los estudios iniciales mostraron esofagitis, pero en quien los síntomas no mejoraron con el tratamiento clásico para enfermedad ácido péptica y en quien estudios imagenológicos adicionales sugerían el síndrome de Wilkie como causa de los síntomas. Discusión y Conclusión: Se trata de una patología que debe conocerse y considerar en paciente con historia de pérdida de peso, marcada intolerancia a la vía oral y falta de respuesta al manejo.


Introduction: Wilkie syndrome is a rare cause of upper gastrointestinal tract obstruction, it is characterized by a decrease in the aorto-mesenteric angle that results in a compression of the third portion of the duodenum causing high obstructive symptoms. Case Report: We present the case of a 64-year-old woman, with a history of abdominal pain, heartburn, early satiety, and intolerance to the oral route, in whom initial studies showed esophagitis, but in whom symptoms did not improve with the classic treatment for peptic acid disease, additional imaging studies suggested Wilkie syndrome. Discussion and Conclusión: It is a pathology that must be known and suspected in patients with a history of weight loss, marked intolerance to oral intake, and lack of treatment response.


Subject(s)
Humans , Female , Middle Aged , Superior Mesenteric Artery Syndrome/complications , Duodenal Diseases/etiology , Intestinal Obstruction/etiology , Jejunal Diseases/etiology , Superior Mesenteric Artery Syndrome/surgery , Tomography, X-Ray Computed , Duodenal Diseases/surgery , Abdomen/diagnostic imaging , Jejunal Diseases/surgery
15.
Saudi Med J ; 42(10): 1145-1148, 2021 Oct.
Article in English | MEDLINE | ID: mdl-34611011

ABSTRACT

OBJECTIVES: To determine the prevalence of superior mesenteric artery (SMA) syndrome in patients presenting with abdominal pains, and to evaluate computed tomographic (CT) findings needed for its diagnosis. METHODS: This retrospective record-based study was carried out at the radiology department, from January 2016 to January 2021. All young patients (aged under 25) who underwent CT scans for abdominal pains were reviewed. Post-surgery, tumor, and trauma cases were excluded. Imaging findings for SMA syndrome were recorded as 'suggestive' (reduced aortomesenteric angle and distance with proximal duodenal dilatation), 'possible' (reduced angle and distance without proximal duodenal dilatation) and 'probable' (reduction of either angle or distance). Two radiologists interpreted the findings and consensus reporting was made. Diagnoses were confirmed on clinical grounds (symptomatic improvement by specific treatment and exclusion of other diagnoses), or barium studies. Imaging findings were compared to final diagnoses. McNemar's Chi-square test was used to determine association. RESULTS: Out of 141 patients (mean age=10.8, standard deviation=4), 7 (4.9%) patients mostly females were having SMA syndromes based on 'suggestive' imaging criteria (p=0.0005), and one patient underwent surgery. CONCLUSION: Superior mesenteric artery syndrome is not an uncommon condition and should be considered in differential diagnosis of acute abdomen in young patients after excluding other diagnoses.


Subject(s)
Superior Mesenteric Artery Syndrome , Abdominal Pain/diagnostic imaging , Abdominal Pain/etiology , Aged , Child , Duodenum , Female , Humans , Male , Retrospective Studies , Superior Mesenteric Artery Syndrome/complications , Superior Mesenteric Artery Syndrome/diagnostic imaging , Tomography, X-Ray Computed
16.
Rev. bras. ortop ; 56(4): 523-527, July-Aug. 2021. graf
Article in English | LILACS | ID: biblio-1341167

ABSTRACT

Abstract Vascular compression of the third part of the duodenum by the superior mesenteric artery results in an unusual occlusion of the duodenal transit known as superior mesenteric artery syndrome. This syndrome can occur after surgeries to correct spinal deformities in a rate ranging from 0.5% to 4.7%. It results from a positional alteration of the artery emergency point due to a change in trunk length after surgery. It is associated with risk factors such as low body mass index and weight loss. Patients usually present with intestinal occlusion, abdominal pain, nausea, bilious vomiting, and early satiety. Superior mesenteric artery syndrome must be recognized early to institute an adequate treatment, which can be clinical (with gastric tube for decompression and nutritional support) or require a surgical procedure. Secondary complications related to superior mesenteric artery syndrome include delayed surgical and nutritional recovery, healing problems, and prolonged hospitalization. The present study aims to report a case of superior mesenteric artery syndrome in a patient with neuromuscular scoliosis secondary to a transverse myelitis who underwent surgical treatment for spinal deformity correction.


Resumo A compressão vascular da terceira parte do duodeno pela artéria mesentérica superior resulta no desenvolvimento de uma condição incomum de oclusão do trânsito duodenal conhecida como síndrome da artéria mesentérica superior. Este fenômeno pode acontecer após cirurgias de correção de deformidades da coluna, e sua taxa de ocorrência é de 0,5 a 4,7% dos casos. Isso ocorre em virtude da alteração do posicionamento do ponto de emergência da artéria, decorrente da mudança do comprimento do tronco após a cirurgia, e está associado a fatores de risco, como baixo índice de massa corpórea e perda ponderal. Os pacientes costumam se apresentar com um quadro de oclusão intestinal, com dor abdominal, náusea, vômito bilioso e saciedade precoce. O reconhecimento desta condição é importante para instituir o tratamento adequado, que varia do tratamento clínico, com sondagem e descompressão gástrica associados a suporte nutricional; à necessidade de abordagem cirúrgica. Complicações secundárias relacionadas à síndrome da artéria mesentérica superior incluem: recuperação cirúrgica e nutricional retardadas, problemas com a cicatrização e hospitalização prolongada. O objetivo do presente estudo é relatar um caso de síndrome da artéria mesentérica superior, ocorrido em um paciente com escoliose neuromuscular secundária a sequela de mielite transversa, submetido ao tratamento cirúrgico da deformidade da coluna.


Subject(s)
Humans , Male , Child , Scoliosis/surgery , Spinal Fusion , Superior Mesenteric Artery Syndrome/complications , Intestinal Obstruction
17.
Medicine (Baltimore) ; 100(28): e26611, 2021 Jul 16.
Article in English | MEDLINE | ID: mdl-34260546

ABSTRACT

RATIONALE: Nutcracker and superior mesenteric artery (SMA) syndrome share the same pathogenesis, but the simultaneous occurrence of both diseases is quite rare. A combination of the nutcracker syndrome and IgA nephropathy has previously been reported. Herein, we report what we believe is the first case of coexisting nutcracker and SMA syndrome in a patient with IgA nephropathy. PATIENT CONCERNS: A 15-year-old Chinese boy who was diagnosed with IgA nephropathy at 8 years of age presented with gross hematuria, fatigue, anorexia, nausea, and recurrent abdominal distension for 1 week without any obvious evidence of preceding infection. Laboratory data showed macroscopic hematuria, heavy proteinuria, and relatively normal renal function. Doppler ultrasonography and upper gastrointestinal gastrografin study were performed, respectively. Since his renal function deteriorated after admission, repeated renal biopsy was performed. DIAGNOSES: IgA nephropathy with nutcracker phenomenon and SMA syndrome. INTERVENTION: Immunosuppressive therapy combined with conservative therapy for superior mesenteric artery syndrome. OUTCOMES: One month later, his abdomen symptoms such as anorexia and abdominal distension eased a lot with body weight increase of about 3 kg. After 6 months of follow-up, his body weight increased to 57 kg, serum creatinine decreased to 63 µmol/L, and urine microscopy showed 75.5 RBC/high-power field with 0.3 g urine protein per day. LESSONS: Although the association between vascular compression and IgA nephropathy (IgAN) has not been elucidated yet, combination of nutcracker syndrome and SMA syndrome should be considered in patients with IgAN. The combination may increase the complexity of the disease, and renal biopsy should not be hesitated for differential diagnosis.


Subject(s)
Glomerulonephritis, IGA/complications , Renal Nutcracker Syndrome/complications , Superior Mesenteric Artery Syndrome/complications , Adolescent , Humans , Male
18.
Clin Imaging ; 78: 35-37, 2021 Oct.
Article in English | MEDLINE | ID: mdl-33725497

ABSTRACT

Superior mesenteric artery (SMA) syndrome in association with abdominal aortic aneurysm (AAA) is exceedingly rare and has been noted to occur in patients with severe abdominal pain, bilious emesis, and a history of tobacco use. When symptoms of small bowel obstruction occur, it is imperative to investigate further with cross-sectional imaging to determine the etiology. Conservative management is preferred, but in cases of SMA syndrome with concomitant AAA, aneurysm repair should be considered, regardless of size, if initial treatment fails.


Subject(s)
Aortic Aneurysm, Abdominal , Superior Mesenteric Artery Syndrome , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnostic imaging , Humans , Mesenteric Artery, Superior/diagnostic imaging , Pain , Superior Mesenteric Artery Syndrome/complications , Superior Mesenteric Artery Syndrome/diagnostic imaging , Tomography, X-Ray Computed
19.
BMJ Case Rep ; 14(2)2021 Feb 23.
Article in English | MEDLINE | ID: mdl-33622741

ABSTRACT

Superior mesenteric artery (SMA) syndrome is an uncommon entity leading to compression of the duodenum between the aorta and the SMA. Normally the coeliac trunk and the superior mesenteric arteries have distinct origins from the abdominal aorta. The celiacomesenteric trunk (CMT) is the least frequently reported anatomic variation of all abdominal vascular anomalies. CMT denotes a common trunk of origin of the coeliac and superior mesenteric arteries. The coexistence of these anomalies has never been reported in the literature. We present a case of a 59-year-old man presenting with duodenal obstruction due to SMA syndrome with CMT. The aortomesenteric angle was 13 degrees and SMA-aorta distance was 8 mm. Patient underwent a gastrojejunostomy. After an uneventful recovery, the patient has been symptom free for 1-year follow-up.


Subject(s)
Duodenal Obstruction , Superior Mesenteric Artery Syndrome , Aorta, Abdominal/diagnostic imaging , Celiac Artery/diagnostic imaging , Humans , Male , Mesenteric Artery, Superior/diagnostic imaging , Middle Aged , Superior Mesenteric Artery Syndrome/complications , Superior Mesenteric Artery Syndrome/diagnostic imaging
20.
Rev Esp Enferm Dig ; 113(5): 372-374, 2021 May.
Article in English | MEDLINE | ID: mdl-33406845

ABSTRACT

A 67-year-old female was referred due to epigastric pain, vomiting and weight loss of 6 kg in the past months. Blood tests were performed showing hematuria. An abdominal Doppler ultrasound did not show anything abnormal. Thus, an abdominal computed tomography (CT) angiography and a magnetic resonance imaging (MRI) enterography were performed, objectifying an aortomesenteric angle of 10.8° (reference range 38-56°), which caused a complete collapse of the left renal vein ("nutcracker phenomenon") and duodenal compression with retrograde dilatation ("Wilkie syndrome"). Conservative measures and nutritional support were adopted during hospitalization. She was discharged due to a good tolerance to an oral diet, the absence of symptoms and a good contrast pass in the esophagogastroduodenal transit.


Subject(s)
Renal Nutcracker Syndrome , Superior Mesenteric Artery Syndrome , Abdominal Pain/etiology , Aged , Duodenum , Female , Humans , Renal Nutcracker Syndrome/complications , Renal Nutcracker Syndrome/diagnostic imaging , Renal Veins/diagnostic imaging , Superior Mesenteric Artery Syndrome/complications , Superior Mesenteric Artery Syndrome/diagnostic imaging
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