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Superior mesenteric artery syndrome

Teodor Kozhuharov, Adrian Petkov, Rozen Grigorov, Vyara Draganova, Plamen Chernopolski


Introduction: Superior Mesenteric Artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction that occurs when the descending part of the duodenum is compressed between the su­perior mesenteric artery and the abdominal aorta. The result is chronic or acute obstruction of the duodenum, which may be either complete or partial. The acute type is more common and general­ly caused by reduced perivascular fat surrounding the abdominal aorta and the superior mesenter­ic artery.

Materials and Methods: A 59-year-old male patient presented in our emergency department with a complaint of upper abdominal pain, nausea, vomiting and abdominal distention for three days. Bloated abdomen with tenderness to palpation was found during the physical examination. Ultra­sonography revealed small bowel loops dilated to 41 mm and a moderate amount of liquid around the liver and the small bowel. The X-ray confirmed the same results. The patient was scheduled for an operative intervention -he underwent a midline laparotomy. Volvulus, causing intestinal obstruc­tion was found.

Results: Resection of the strangulated bowel was performed, due to necrosis of the intestines. The passage was restored via latero-lateral anastomosis and the small amount of ascites was aspirated. As an additional finding Superior Mesenteric Artery syndrome was discovered (Wilkie`s syndrome). Af­ter a normal postoperative period without complications the patient was discharged on the seventh day.

Conclusion: Despite being a very uncommon condition, early recognition and appropriate measures for Superior Mesenteric Artery syndrome are critical to prevent the development of severe compli­cations. Upper gastrointestinal endoscopy may be necessary to exclude mechanical causes of duode­nal obstruction. Contrast computed tomography scan can be helpful for establishing the diagnosis of SMA syndrome.


Superior Mesenteric Artery syndrome; obstruction; volvulus; laparotomy; ascites



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