A forgotten disease: Superior mesenteric artery syndrome

Aim: Superior mesenteric artery syndrome (SMAS) is a rare cause of upper gastrointestinal obstruction. As it is encountered infrequently, there have been only a few studies on it, mostly in the form of case series or just a case presentation in the literature. In this study, we aim to investigate common clinical features and radiological measurements between patients admitted with symptoms of gastric outlet obstruction due to SMAS and those without SMAS. Material and Method: This study was conducted prospectively on individuals admitted to our clinic presenting with symptoms of gastric outlet obstruction in the previous six months and who had undergone computerized tomography. (Here, SMAS is defined by a narrow aortomesenteric angle and a short aortomesenteric distance.) Demographic features and radiological measurements were compared between patients with and without SMAS. The results of a three-month follow-up of each subject with SMAS were recorded. Results: This study includes a total of 92 subjects, 14 (15%) of whom had a diagnosis of SMAS (Group 1) and 78 (85%) of whom did not (Group 2). Group 1 had a predominance of female and significantly younger patients (mean age: 31.1 +/- 10.2), compared to Group 2 (mean age: 44 +/- 11.7) (p < 0.001). Abdominal subcutaneous fat tissue thickness was thinner in group 1 than in group 2 (18.1 +/- 8.1 and 23.7 +/- 12.2, respectively; p = 0.039). Eleven of the 14 SMAS patients (78.5%) recovered with medical treatment, but in the other three cases, surgical intervention was considered. Discussion: SMAS is an important and preventable cause of small bowel obstruction. Although it is a rare condition in the general population, accurate diagnosis of the disease leads to improvement of symptoms; simple medical management can preclude the need for surgery.