SUPERIOR MESENTERIC ARTERY SYNDROME: CLINICAL, ENDOSCOPICAL AND RADIOLOGICAL CORRELATIONS ACCORDING TO A SINGLE-CENTER EXPERIENCE

Abstract

Background and aim: The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss, due to the compression of the third part of duodenum between the aorta and the SMA. Studies to determine the optimal methods of diagnosis and treatment are essential. This study aims to analyze the clinical presentation, the doagnosis and the management of this syndrome. Material and medthods: Over a 2-year (2013-2014), 8 cases of SMA syndrome (out of 2074 esophago-gastro-duodenoscopies, EGDS) were initially suspected through EGDS. Therefore, these patients performed computed tomography (CT) scan to confirm the diagnosis. Once the diagnosis was confirmed, the patients were referred to a gastroenterologist and to a nutritionist to discuss a personalized approach of therapy; furthermore, for each patient a surgical consultation was proposed. Results: In our series we evaluated retrospectively 8 cases of SMA (6 females), with a prevalence of 0,004%. Median age was 23,5 years (range 14-40), and median weight was 47,5 kilos (range 40-84). the median body mass index was 21 kilos/m2. Symptoms developed between 6 to 24 months (median 12). Premorbid conditions were present in four patients (anorexia nervosa in two patients, spina bifida and Crohn's disease in two patients). Only 2 of 8 patients were hospitalized, due to severe malnutrition. Median aorto-mesenteric angle was 22, and median aorta-SMA distance was 5 mm. Interestingly, all the patients improved on conservative treatment. Conclusions: To date, SMS syndrome represents a diagnostic and therapeutic challenge. With regard to previous series published, our results show: the importance of the endoscopic suspicion of SMA syndrome, confirmed by CT scan; the preponderance of a longstading and chronic onset; a female preponderance; the importance of the nutritional counseling in the therapeutic approach; the absence of need for surgical intervention; the better diagnostic accuracy of the narrowing of the aorta-SMA distance, rather than the narrowing of the aortomesenteric angle. Further prospective studies, with a larger number of patients, are needed to clarify the best way to diagnose nd manage SMA syndrome.