Superior Mesenteric Artery(SMA) Syndrome: Understanding What is it ?
Commonly known as Willkie syndrome, superior mesenteric artery syndrome is one of the rare duodenal conditions. It is characterized by the blockage in the intestine which can even be fatal if the treatment for this condition is not started soon. Even though this disease is rare, it is very important to know about it because of its excruciating symptoms and the chance of becoming fatal. It is often seen in the patients with SMA syndrome that their condition is not well treated with conservative medicinal procedures. However, there are some surgeries, of less invasive nature, which are seen to work safely as a treatment option for this condition.
What is SMA syndrome?
In superior mesenteric artery syndrome, a portion of duodenum is compressed due to aorta of abdomen and superior mesenteric artery. This artery is one of the primary arteries of aorta. Usually there is a fat tissue between these two arteries but when is fat is dissolved due to some cause, duodenal compression is caused. Due to this compression, the movement of inflammatory bowel disease in small intestines is obstructed and can lead to severe damage in the duodenum. The most common sign of this syndrome is weight loss.
Some risk factors of SMA syndrome
The compression in duodenum due to degreased angle between aorta and mesenteric artery can be acquired or congenital. However, there are some risk factors of this disease:
- Surgical procedures such as correction of scoliosis
- Short ligament of treitz by birth
- Abdominal aortic aneurysm
- Mesenteric root neoplasm
- Ladd’s bands
- Lumber hyperlordosis
Are there any known causes of superior mesenteric artery syndrome?
There are some associations of SMA syndrome with potential causes such as:
- Significant loss of weight
- Abnormal increase in metabolism
- Some conditions related to diet such as malabsorptive disease
- Some kind of surgery in the abdomen
- Body braces
- HIV positive
- Cancer
Some symptoms of superior mesenteric artery syndrome
Most symptoms superior mesenteric artery cause are not clear and specific this condition. This makes the early diagnosis of this disease challenging. Symptoms of SMA syndrome can appear gradually or even abruptly. Some common symptoms of this disease are:
- Epigastric pain usually after eating something
- Vomiting and nausea
- Irritable abdomen
- Unusual weight loss
- Pain to worsen in supine position
- Esophageal acid reflux
- Bloated abdomen
- Cycles of vomiting
- Pain in the chest
- Loss of appetite
Are there some ways to diagnose SMA syndrome even after its vague symptoms?
The diagnosis of this disease includes the combination of understanding symptoms and radiological techniques. Some imaging tests for this syndrome are:
- X ray is used to determine any signs of dilated stomach or bowel gas
- Barium X ray
- Endoscopy is helpful in ruling out any complications caused by SMA syndrome such as
- Gastric stasis
- Biliary reflux
- Gastritis
- Severe obstruction in duodenum
- Doppler ultrasound is carried out to determine the flow of blood through the arteries
- CT scan is the best diagnostic test for this syndrome as it directly measures the aorto-mesenteric angle
- Magnetic resonance angiography
What are the options of treatment for superior mesenteric artery syndrome?
The treatment of SMA syndrome starts with non invasive conservative management of the conditions with the aim of increasing the fat cushion which would in turn increase AO angle. Some of the common management protocols for patients with this disease are:
- Correction of electrolyte balance in the body
- Maintaining hemodynamics
- Giving nutrition through vein is very necessary
- Inserting a special tube which will carry medicines and food to gut via nose
- Giving very tiny meals to the patient
- Therapeutic postures for SMA syndrome
As there is a high chance that conservative treatment of SMA syndrome will not work for the patient, they may have to consider different surgical treatment options such as:
- Gastrojejunostomy
- Laparoscopic duodenojejunostomy
- Division of ligament of Treitz
What is the advantage of laparoscopic duodenojejunostomy over open bypass?
Open bypass surgery was the first procedural treatment for superior mesenteric artery syndrome. However, when the first laparoscopic duodenojejunostomy was performed successfully on the patient, many advantages of it were clearly apparent over the previous procedure. It is seen that this treatment option is even suitable for the patients who have suffered from failed conservative treatment of SMA syndrome. In many patients the symptoms of SMA syndrome is completely removed due to this treatment. The reported success rate of this treatment is 80% to 100%.
Conclusion
Superior mesenteric artery treatment for its syndrome involves doctors from many fields as it is a rare and complicated condition. A general physician as the first doctor to see the SMA patient in the emergency department, a well abled radiologist to run the diagnostic tests on the patient, a gastroenterologist who acts as the most important professional in this condition as it is the responsibility of this doctor to diagnose and lay out treatment plan for the patient and lastly a general surgeon to execute the needed surgery on the patient is needed for SMA syndrome. There should not be any kind of negligence for dealing with the complications and symptoms superior mesenteric artery cause. For this you must find a professional gastroenterologist as he is the one who will decide your treatment plant. To get in touch with the most experienced and skillful doctors for the treatment of superior mesenteric artery syndrome, contact Alfa Gastro and Liver care immediately.