Acute Kidney Injury Caused by Superior Mesenteric Artery Syndrome

Background. Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction leading to acute kidney injury (AKI). Methods. We report a case of 23-year-old army personnel who presented with persistent vomiting leading to severe hypokalaemia, metabolic alkalosis, and acute kidney injury resulting in cardiorespiratory arrest. Results. After successful resuscitation, he was supported with haemodialysis and aggressive electrolytes correction. He was repeatedly not able to tolerate nasogastric (NG) tube feeding and computerised tomography of abdomen was performed, and the diagnosis of SMA syndrome was made. Gastroscopy examination revealed duodenal ulcer at D1, pinhole D1-D2 junction, but there was no evidence of intraluminal mass or lesions leading to upper gastrointestinal obstruction. A nasojejunal tube was inserted to bypass the narrow segment of the duodenum, and he was put on nutritional support. He was subsequently weaned off dialysis support as his renal function gradually improved and later on normalised. He remains symptoms free, and he gained five kilograms in four months after discharge. Conclusions. SMA syndrome is a rare cause of upper gastrointestinal obstruction but should be considered as a differential diagnosis in a patient who presented with recurrent vomiting and AKI with metabolic alkalosis.

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Case Report of a Superior Mesenteric Artery Syndrome in an Autistic Patient with Schizophrenia

Borneo Journal of Medical Sciences (BJMS) ◽

10.51200/bjms.vi.2948 ◽

2021 ◽

pp. 21

Author(s):

Lee Mem Tim ◽

Bernard Ho Kar Eng ◽

Sentilnathan Subramaniam ◽

Harivinthan Sellappan

Keyword(s):

Computed Tomography ◽

Case Report ◽

Ct Scan ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Superior Mesenteric Artery Syndrome ◽

Autistic Patient ◽

Gastrointestinal Obstruction ◽

Sma Syndrome ◽

Upper Gastrointestinal

Introduction: Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction. Diagnosis is confirmed via computed tomography (CT) scan showing acute angulation at the origin of superior mesenteric artery compressing on the duodenum causing proximal dilatation of the second part of duodenum.

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Wilkie's Syndrome or Superior Mesenteric Artery Syndrome: Fact or Fantasy

Case Reports in Gastroenterology ◽

10.1159/000431307 ◽

2015 ◽

Vol 9 (2) ◽

pp. 194-199 ◽

Cited By ~ 22

Author(s):

Vera Zaraket ◽

Liliane Deeb

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Early Recognition ◽

Fatty Tissue ◽

Non Invasive ◽

Wilkie’S Syndrome ◽

Gastrointestinal Obstruction ◽

Sma Syndrome ◽

Upper Gastrointestinal ◽

High Intestinal Obstruction

Superior mesenteric artery (SMA) syndrome (known as Wilkie's syndrome) is a rare cause of upper gastrointestinal obstruction. It is an acquired disorder in which acute angulation of the SMA causes compression of the third part of the duodenum between the SMA and the aorta. This is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a 17-year-old female who presented with intermittent abdominal pain and intractable vomiting following significant weight loss after hospitalization for pneumonia. Symptoms persisted for 2 years and the patient underwent extensive invasive and non-invasive tests, but to no avail. Thereafter she developed acute high intestinal obstruction, which unraveled her diagnosis. This case emphasizes the challenges in the diagnosis of SMA syndrome and the need for increased awareness of this entity. This will improve early recognition in order to reduce irrelevant tests and unnecessary treatments.

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Superior mesenteric artery syndrome: a rare case of upper gastrointestinal obstruction

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz054 ◽

2019 ◽

Vol 2019 (3) ◽

Author(s):

Dimosthenis Chrysikos ◽

Theodore Troupis ◽

John Tsiaoussis ◽

Markos Sgantzos ◽

Vasileios Bonatsos ◽

...

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Rare Case ◽

Superior Mesenteric Artery Syndrome ◽

Gastrointestinal Obstruction ◽

Upper Gastrointestinal

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Superior Mesenteric Artery Syndrome: A Rare Mimic of Common Causes of Upper Gastrointestinal Obstruction

Euroasian Journal of Hepato-Gastroenterology ◽

10.5005/jp-journals-10018-1098 ◽

2014 ◽

Vol 4 (1) ◽

pp. 58-60 ◽

Cited By ~ 1

Author(s):

Gayatri Madhab ◽

Jette Madsen ◽

Eva Brems Dalgaard ◽

Arindam Bharadwaz

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Superior Mesenteric Artery Syndrome ◽

Gastrointestinal Obstruction ◽

Common Causes ◽

Upper Gastrointestinal

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Wilkie’s Syndrome: Case Report

Surgical Case Reports ◽

10.31487/j.scr.2020.09.07 ◽

2020 ◽

pp. 1-2

Author(s):

Vladimir Schraibman ◽

Marina Epstein ◽

Gabriel Maccapani ◽

Franco Milan Sapuppo ◽

...

Keyword(s):

Weight Loss ◽

Case Report ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Treatment Options ◽

Diagnostic Study ◽

Postprandial Fullness ◽

Wilkie’S Syndrome ◽

Gastrointestinal Obstruction ◽

Upper Gastrointestinal

Superior mesenteric artery (SMA) syndrome (known as Wilkie's syndrome) is a rare cause of upper gastrointestinal obstruction. A 34-year-old woman presented with nonspecific symptoms of postprandial fullness and important weight loss. After screening for other pathologies, it was diagnosed Wilkie’s syndrome. Within this case it was briefly reviewed the diagnostic study and treatment options including a description of the selected approach, a robotic duodenojejunostomy.

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Superior mesenteric artery (SMA) syndrome: an unusual cause of intestinal obstruction in palliative care

Annals of Palliative Medicine ◽

10.21037/apm.2016.07.03 ◽

2017 ◽

Vol 6 (1) ◽

pp. 91-93 ◽

Cited By ~ 1

Author(s):

Chun-Yan So ◽

Kwok-Ying Chan ◽

Ho-Yan Au ◽

Man-Lui Chan ◽

Theresa Lai

Keyword(s):

Palliative Care ◽

Intestinal Obstruction ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Sma Syndrome

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A clinical course of a patient with anorexia nervosa receiving surgery for superior mesenteric artery syndrome

Journal of Eating Disorders ◽

10.1186/s40337-021-00436-2 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Ken Kurisu ◽

Yukari Yamanaka ◽

Tadahiro Yamazaki ◽

Ryo Yoneda ◽

Makoto Otani ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Anorexia Nervosa ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Rare Complication ◽

Nutrition Therapy ◽

Psychological Status ◽

Sma Syndrome

Abstract Background Superior mesenteric artery (SMA) syndrome is a well-known but relatively rare complication of anorexia nervosa. Although several reports have proposed surgery for SMA syndrome associated with anorexia nervosa, these have shown poor outcomes or did not reveal the long-term weight course. Thus, the long-term effectiveness of surgery for SMA syndrome in such cases remains unclear. This case report describes a patient with anorexia nervosa who underwent surgery for SMA syndrome. Case presentation An 18-year-old woman presented with anorexia nervosa when she was 16 years old. She also presented with SMA syndrome, which seemed to be caused by weight loss due to the eating disorder. Nutrition therapy initially improved her body weight, but she ceased treatment. She reported that symptoms related to SMA syndrome had led to her weight loss and desired to undergo surgery. Laparoscopic duodenojejunostomy was performed, but her body weight did not improve after the surgery. The patient eventually received conservative nutritional treatment along with psychological approaches, which led to an improvement in her body weight. Conclusions The case implies that surgery for SMA syndrome in patients with anorexia nervosa is ineffective for long-term weight recovery and that conservative treatment can sufficiently improve body weight; this is consistent with the lack of evidence on the topic and reports on potential complications of surgery. Due to difficulties in assessing psychological status, consultation with specialists on eating disorders is necessary for treating patients with severely low body weight.

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Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings

Gastroenterology Research and Practice ◽

10.1155/2018/1937416 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Emanuele Sinagra ◽

Dario Raimondo ◽

Domenico Albano ◽

Valentina Guarnotta ◽

Melania Blasco ◽

...

Keyword(s):

Weight Loss ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Control Group ◽

Diagnosis And Management ◽

Sma Syndrome ◽

Aortomesenteric Angle ◽

Cect Scan ◽

Enhanced Computed Tomography ◽

Aortomesenteric Distance

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.

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