Ali Azizi

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By Ali Azizi Alborz Hedayati
Superior Mesenteric Artery Syndrome
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Superior Mesenteric Artery Syndrome
Male adult. Celiac trunk (ct) left gastric
artery (lga) splenic artery (sa) common hepatic
artery (cha) superior mesenteric artery (sma)
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Superior Mesenteric Artery Syndrome
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Superior Mesenteric Artery Syndrome
Compression of 3rd portion of duodenum between
the aorta and superior mesenteric artery (SMA)
Females gtmales
Pathophysiology
Narrowing of angle between SMA and aorta SMA
usually forms an angle of 45 degrees with the
aorta
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Superior Mesenteric Artery Syndrome
Etiologies

• Prolonged bed rest in supine position (body cast,
  whole-body burns, surgery)
• Substantial and, frequently, rapid weight loss
• Anorexia nervosa or malnutrition
• Loss of abdominal muscle tone (as in pregnancy)
• May be congenital
• Seen in those with asthenic build
• Exaggerated lumbar lordosis

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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

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Superior Mesenteric Artery Syndrome
Imaging findings
Usually requires upper GI or CT of abdomen for
diagnosis
Megaduodenum Pronounced dilation of 1 st and 2nd
portion of
duodenum and frequently stomach Best seen in
supine position Compression of duodenum between
aorta and SMA
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Upper gastrointestinal tract series shows
dilatation of second portion of duodenum.
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Upper gastrointestinal series showing duodenal
dilation (white arrow).
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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 )
SMAgtred
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Computed tomography shows narrowing between
superior mesenteric artery and aorta, with
dilatation of second portion of duodenum.
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Abdominal and pelvic CT scan showing duodenal
compression (black arrow) by the abdominal aorta
and the superior mesenteric artery
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