A comprehensive review of superior mesenteric artery syndrome

BACKGROUND: Superior mesenteric artery syndrome is one of the rarest gastrointestinal disorders known to medical science; characterized by the vascular compression of the third part of duodenum, in the angle between the superior mesenteric artery and the aorta, presenting as an uncommon cause of upper intestinal obstruction. This review article highlights the basic theoretical aspects of the syndrome. METHODS: The data for the present review were obtained by searching in PubMed and other databases using the key terms "superior mesenteric artery syndrome", "Wilkie's syndrome", "arteriomesenteric duodenal compression syndrome", "chronic duodenal ileus", "cast syndrome", and "duodenojejunostomy". Many original articles, reviews, and interesting case reports were selected. RESULTS: Superior mesenteric artery syndrome is frequently associated with various predisposing conditions which may result in rapid weight loss leading to loss of retroperitoneal fatty tissue and hence, narrowing of the aortomesenteric angle. The nonspecific symptoms very often cause a delay in diagnosis and 95% cases are diagnosed by radiographic studies. Conservative treatment with nutritional supplement is the initial approach to reverse the pathogenesis but however, over 75% cases may need definitive surgical treatment. CONCLUSIONS: The possibility of superior mesenteric artery syndrome should be considered in patients with nonspecific signs and symptoms of upper gastrointestinal tract obstruction. Computed tomography angiography is considered as the gold standard for diagnosis and in case of failure of medical treatment, open duodenojejunostomy and laparoscopic duodenojejunostomy have been described as the best surgical treatment option.