Vascular Compression of the Duodenum (SMA Syndrome)

Content below is from a textbook reference chapter (Sabiston Ch50 - Diverticular Disease & Miscellaneous Problems), not primary literature.

Definition and cause

Also known as superior mesenteric artery (SMA) syndrome or Wilkie syndrome — a rare condition characterized by compression of the third portion of the duodenum by the superior mesenteric artery as it passes over this portion of the duodenum. Symptoms include profound nausea and vomiting, abdominal distention, weight loss, and postprandial epigastric pain, which varies from intermittent to constant depending on severity of the duodenal obstruction. Weight loss usually occurs before the onset of symptoms and contributes to the syndrome.

Most commonly seen in young asthenic individuals, with women more commonly affected than men. Predisposing factors, aside from weight loss, include supine immobilization, scoliosis, and placement of a body cast (sometimes called the cast syndrome). An association between vascular compression of the duodenum and peptic ulcer has been observed. Vascular compression of the duodenum has been reported in association with anorexia nervosa and after proctocolectomy and J-pouch anal anastomosis, resection of an arteriovenous malformation of the cervical cord, abdominal aortic aneurysm repair, and orthopedic procedures (usually spinal surgery). One reported case series described a family with a preponderance of vascular compression of the duodenum.

Diagnosis

Made by a barium upper GI series (Fig. 50.49) or hypotonic duodenography, demonstrating abrupt or near-total cessation of flow of barium from the duodenum to the jejunum. CT is useful in certain cases.

Treatment

Varies. Conservative measures should be tried initially and have been increasingly successful as definitive treatment. Operative management may include duodenojejunostomy, gastrojejunostomy to bypass the obstructing segment, or duodenal derotation (Strong procedure).

Open items / gaps

• No primary literature yet in the wiki on SMA syndrome — entirely textbook-reference-derived.
• This is the final entity from the Sabiston Small Bowel chapter, completing the full 61-page chapter ingest.