Overview
Superior mesenteric artery syndrome (SMAS) is characterized by duodenal obstruction due to compression from the superior mesenteric artery against the abdominal aorta, often triggered by conditions that decrease the mesenteric angle 1.Diagnosis
Key Diagnostic Criteria: Abrupt vertical cutoff of barium flow in the third portion of the duodenum on imaging 1.
Recommended Tests: Barium upper gastrointestinal series for radiological confirmation 1.Management
First-Line Treatments:
- Gastrointestinal decompression (e.g., nasogastric tube) 1.
- Proper positioning (e.g., side-lying position) 1.
- Adequate nutritional support 1.
Adjunctive Treatments: Surgical correction may be necessary in refractory cases 1.Special Populations
Neurological Conditions: SMAS can occur post-surgical resection of cervical cord arteriovenous malformations, requiring careful management in incomplete quadriplegic patients 1.Key Recommendations
Diagnose SMAS using radiological imaging showing an abrupt cutoff in the third portion of the duodenum (Evidence: Moderate 1).
Initiate management with gastrointestinal decompression, positional adjustments, and nutritional support (Evidence: Expert opinion 1).
Consider surgical intervention for patients who do not respond to medical management (Evidence: Weak 1).References
1 Balmaseda MT, Gordon C, Cunningham ML, Clairmont AC. Superior mesenteric artery syndrome after resection of an arteriovenous malformation in the cervical cord. The American journal of gastroenterology 1987. link