1. Superior Mesenteric Artery Syndrome
By:
Ali Azizi
Alborz Hedayati
Superior Mesenteric Artery Syndrome

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

3. Superior Mesenteric Artery Syndrome

4. 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

7. 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

8. Superior Mesenteric Artery Syndrome
Clinical findings
Epigastric pain
Nausea
Repetitive vomiting
Abdominal cramping
Typically findings are worst in supine position and may be relived by changing to the prone or left lateral decubitus positions
Associated with a higher than normal incidence of peptic ulcer disease and hyperchlorhydria

9. 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

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

11. Upper gastrointestinal series showing duodenal dilation (white arrow).

12. 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

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

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

17. Thank you