by: ali azizi alborz hedayati
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By: Ali Azizi Alborz Hedayati. Superior Mesenteric Artery Syndrome. Superior 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. - PowerPoint PPT PresentationTRANSCRIPT
ByBy::Ali AziziAli Azizi
Alborz HedayatiAlborz Hedayati
Superior 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
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
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