ByBy::Ali AziziAli Azizi

Alborz HedayatiAlborz Hedayati

Superior Mesenteric Artery SyndromeSuperior Mesenteric Artery SyndromeSuperior Mesenteric Artery SyndromeSuperior Mesenteric Artery Syndrome

Male adult. Celiac trunk (ct); left gastric artery (lga); splenic artery (sa); common hepatic artery (cha); superior mesenteric artery (sma)

Superior Mesenteric Artery Syndrome

Superior Mesenteric Artery Syndrome

Superior Mesenteric Artery Syndrome

Compression of 3rd portion of duodenum between the aorta and superior mesenteric artery (SMA)

Females >males

Pathophysiology

Narrowing of angle between SMA and aorta SMA usually forms an angle of 45 degrees with the aorta

http://upload.wikimedia.org/wikipedia/commons/b/b6/Cartoon-HealthyAngle.JPG

Etiologies

1.1. Prolonged bed rest in supine position Prolonged bed rest in supine position ((body cast, wholebody cast, whole--body burns, surgery)body burns, surgery) 2.2. Substantial and, frequently, rapid weight lossSubstantial and, frequently, rapid weight loss 3.3. Anorexia nervosa or malnutritionAnorexia nervosa or malnutrition 4.4. Loss of abdominal muscle tone Loss of abdominal muscle tone ((as in pregnancy)as in pregnancy)5.5. May be congenitalMay be congenital 6.6. Seen in those with asthenic buildSeen in those with asthenic build 7.7. Exaggerated lumbar lordosisExaggerated lumbar lordosis

Superior Mesenteric Artery Syndrome

Clinical findings

1. Epigastric pain 2. Nausea 3. Repetitive vomiting 4. Abdominal cramping 5. Typically findings are worst in supine position and may be relived by

changing to the prone or left lateral decubitus positions

6. Associated with a higher than normal incidence of peptic ulcer disease and hyperchlorhydria

Superior Mesenteric Artery Syndrome

Imaging findings

Megaduodenum Pronounced dilation of 1 st and 2nd portion of

duodenum and frequently stomachBest seen in supine position Compression of duodenum between aorta and SMA

Usually requires upper GI or CT of abdomen for diagnosis

Superior Mesenteric Artery Syndrome

Upper gastrointestinal tract series shows dilatation of second portion of duodenum .

Upper gastrointestinal series showing duodenal dilation (white arrow) .

Axial CT scans of the upper abdomen show a dilated 2nd portion of the duodenum (D)just proximal to a narrowed segment of the 3rd portion of the duodenum (green arrow) compressed between the superior mesenteric artery (red arrow)and the aorta (black arrow )

SMA>red

Computed tomography shows narrowing between superior mesenteric artery and aorta, with dilatation of second portion of duodenum.

Abdominal and pelvic CT scan showing duodenal compression (black arrow) by the abdominal aorta and the superior mesenteric artery

Thank youThank you