Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings
Background. The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required. Aims and Methods. This study aims at analyzing the clinical presentat...
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| Language: | English |
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2018-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2018/1937416 |
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| author | Emanuele Sinagra Dario Raimondo Domenico Albano Valentina Guarnotta Melania Blasco Sergio Testai Marta Marasà Vincenzo Mastrella Valerio Alaimo Valentina Bova Giovanni Albano Dario Sorrentino Giovanni Tomasello Francesco Cappello Angelo Leone Francesca Rossi Massimo Galia Roberto Lagalla Federico Midiri Gaetano Cristian Morreale Georgios Amvrosiadis Guido Martorana Marcello Giuseppe Spampinato Vittorio Virgilio Massimo Midiri |
| author_facet | Emanuele Sinagra Dario Raimondo Domenico Albano Valentina Guarnotta Melania Blasco Sergio Testai Marta Marasà Vincenzo Mastrella Valerio Alaimo Valentina Bova Giovanni Albano Dario Sorrentino Giovanni Tomasello Francesco Cappello Angelo Leone Francesca Rossi Massimo Galia Roberto Lagalla Federico Midiri Gaetano Cristian Morreale Georgios Amvrosiadis Guido Martorana Marcello Giuseppe Spampinato Vittorio Virgilio Massimo Midiri |
| author_sort | Emanuele Sinagra |
| collection | DOAJ |
| description | Background. The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required. Aims and Methods. This study aims at analyzing the clinical presentation, diagnosis, and management of SMA syndrome. Ten cases of SMA syndrome out of 2074 esophagogastroduodenoscopies were suspected. A contrast-enhanced computed tomography (CECT) scan was performed to confirm the diagnosis. After, a gastroenterologist and a nutritionist personalized the therapy. Furthermore, we compared the demographical, clinical, endoscopic, and radiological parameters of these cases with a control group consisting of 10 cases out of 2380 EGDS of initially suspected (but not radiologically confirmed) SMA over a follow-up 2-year period (2015-2016). Results. The prevalence of SMA syndrome was 0.005%. Median age and body mass index were 23.5 years and 21.5 kg/m2, respectively. Symptoms developed between 6 and 24 months. Median aortomesenteric angle and aorta-SMA distance were 22 and 6 mm, respectively. All patients improved on conservative treatment. In our series, a marked (>5 kg) weight loss (p=0.006) and a long-standing presentation (more than six months in 80% of patients) (p=0.002) are significantly related to a diagnosis of confirmed SMA syndrome at CECT after an endoscopic suspicion. A “resembling postprandial distress syndrome dyspepsia” presentation may be helpful to the endoscopist in suspecting a latent SMA syndrome (p=0.02). The narrowing of both the aortomesenteric angle (p=0.001) and the aortomesenteric distance (p<0.001) was significantly associated with the diagnosis of SMA after an endoscopic suspicion; however, the narrowing of the aortomesenteric distance seemed to be more accurate, rather than the narrowing of the aortomesenteric angle. Conclusion. SMA syndrome represents a diagnostic and therapeutic challenge. Our results show the following findings: the importance of the endoscopic suspicion of SMA syndrome; the preponderance of a long-standing and chronic onset; a female preponderance; the importance of the nutritional counseling for the treatment; no need of surgical intervention; and better diagnostic accuracy of the narrowing of the aorta-SMA distance. Larger prospective studies are needed to clarify the best diagnosis and management of the SMA syndrome. |
| format | Article |
| id | doaj-art-f0fddae8c8ef464687a3fb2609db9dce |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-f0fddae8c8ef464687a3fb2609db9dce2025-02-03T01:10:32ZengWileyGastroenterology Research and Practice1687-61211687-630X2018-01-01201810.1155/2018/19374161937416Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological FindingsEmanuele Sinagra0Dario Raimondo1Domenico Albano2Valentina Guarnotta3Melania Blasco4Sergio Testai5Marta Marasà6Vincenzo Mastrella7Valerio Alaimo8Valentina Bova9Giovanni Albano10Dario Sorrentino11Giovanni Tomasello12Francesco Cappello13Angelo Leone14Francesca Rossi15Massimo Galia16Roberto Lagalla17Federico Midiri18Gaetano Cristian Morreale19Georgios Amvrosiadis20Guido Martorana21Marcello Giuseppe Spampinato22Vittorio Virgilio23Massimo Midiri24Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalyGastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalyDepartment of Radiology, DIBIMED, University of Palermo, Via del Vespro 127, 90127 Palermo, ItalySection of Cardio-Respiratory and Endocrine-Metabolic Diseases, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, ItalyInternal Medicine Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalyRadiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalyRadiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalyRadiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalyRadiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalyRadiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalyRadiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalyRadiology Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalyEuro-Mediterranean Institute of Science and Technology (IEMEST), 90100 Palermo, ItalyEuro-Mediterranean Institute of Science and Technology (IEMEST), 90100 Palermo, ItalyBioNec, Section of Histology, Department of Experimental and Clinical Neurosciences, University of Palermo, Palermo, ItalyGastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalyDepartment of Radiology, DIBIMED, University of Palermo, Via del Vespro 127, 90127 Palermo, ItalyDepartment of Radiology, DIBIMED, University of Palermo, Via del Vespro 127, 90127 Palermo, ItalyDepartment of Radiology, DIBIMED, University of Palermo, Via del Vespro 127, 90127 Palermo, ItalyGastroenterology Unit, PO. V. Cervello, via Trabucco, 90146 Palermo, ItalyGastroenterology Unit, PO. V. Cervello, via Trabucco, 90146 Palermo, ItalySurgery Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalySurgery Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, ItalyStrategic Direction, Fondazione Istituto Giuseppe Giglio, Cefalù, ItalyDepartment of Radiology, DIBIMED, University of Palermo, Via del Vespro 127, 90127 Palermo, ItalyBackground. The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required. Aims and Methods. This study aims at analyzing the clinical presentation, diagnosis, and management of SMA syndrome. Ten cases of SMA syndrome out of 2074 esophagogastroduodenoscopies were suspected. A contrast-enhanced computed tomography (CECT) scan was performed to confirm the diagnosis. After, a gastroenterologist and a nutritionist personalized the therapy. Furthermore, we compared the demographical, clinical, endoscopic, and radiological parameters of these cases with a control group consisting of 10 cases out of 2380 EGDS of initially suspected (but not radiologically confirmed) SMA over a follow-up 2-year period (2015-2016). Results. The prevalence of SMA syndrome was 0.005%. Median age and body mass index were 23.5 years and 21.5 kg/m2, respectively. Symptoms developed between 6 and 24 months. Median aortomesenteric angle and aorta-SMA distance were 22 and 6 mm, respectively. All patients improved on conservative treatment. In our series, a marked (>5 kg) weight loss (p=0.006) and a long-standing presentation (more than six months in 80% of patients) (p=0.002) are significantly related to a diagnosis of confirmed SMA syndrome at CECT after an endoscopic suspicion. A “resembling postprandial distress syndrome dyspepsia” presentation may be helpful to the endoscopist in suspecting a latent SMA syndrome (p=0.02). The narrowing of both the aortomesenteric angle (p=0.001) and the aortomesenteric distance (p<0.001) was significantly associated with the diagnosis of SMA after an endoscopic suspicion; however, the narrowing of the aortomesenteric distance seemed to be more accurate, rather than the narrowing of the aortomesenteric angle. Conclusion. SMA syndrome represents a diagnostic and therapeutic challenge. Our results show the following findings: the importance of the endoscopic suspicion of SMA syndrome; the preponderance of a long-standing and chronic onset; a female preponderance; the importance of the nutritional counseling for the treatment; no need of surgical intervention; and better diagnostic accuracy of the narrowing of the aorta-SMA distance. Larger prospective studies are needed to clarify the best diagnosis and management of the SMA syndrome.http://dx.doi.org/10.1155/2018/1937416 |
| spellingShingle | Emanuele Sinagra Dario Raimondo Domenico Albano Valentina Guarnotta Melania Blasco Sergio Testai Marta Marasà Vincenzo Mastrella Valerio Alaimo Valentina Bova Giovanni Albano Dario Sorrentino Giovanni Tomasello Francesco Cappello Angelo Leone Francesca Rossi Massimo Galia Roberto Lagalla Federico Midiri Gaetano Cristian Morreale Georgios Amvrosiadis Guido Martorana Marcello Giuseppe Spampinato Vittorio Virgilio Massimo Midiri Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings Gastroenterology Research and Practice |
| title | Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings |
| title_full | Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings |
| title_fullStr | Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings |
| title_full_unstemmed | Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings |
| title_short | Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings |
| title_sort | superior mesenteric artery syndrome clinical endoscopic and radiological findings |
| url | http://dx.doi.org/10.1155/2018/1937416 |
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