Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
Superior mesenteric artery syndrome: a contemporary review of diagnosis and surgical management.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
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Maria Martinez Santos, Anoosh Farooqui, Houssam Osman, Joshua Kong, Shankar Logarajah, Anish Jomy, Rohan Jeyarajah D
Аннотация
BACKGROUND: Superior mesenteric artery syndrome (SMAS) is an uncommon and frequently underdiagnosed cause of proximal intestinal obstruction. It results from the loss of mesenteric fat, leading to a critically narrowed aortomesenteric angle (<22°) and a decreased aortomesenteric distance (<10 mm), causing extrinsic compression of the third portion of the duodenum. The clinical presentation is often nonspecific, with vomiting and abdominal pain being the most common symptoms, contributing to delayed recognition. The diagnosis is established with computed tomography angiography demonstrating a reduced angle and distance, and upper gastrointestinal contrast studies showing gastric dilation with an abrupt contrast cutoff at the third portion of the duodenum. We aimed to review the limited literature on this challenging diagnosis and determine the safest surgical approach focused on outcome.
METHODS: A structured literature review was conducted and presented at the Society of the Alimentary Tract grand rounds, comparing limited studies done at different institutions to gain a better understanding. This study is a literature review and did not involve any human participants or animal subjects; therefore, ethical approval was not required.
RESULTS: Initial management is conservative and focuses on nutritional rehabilitation via nasojejunal or jejunostomy feeding to restore the mesenteric fat pad. When conservative measures fail, surgical intervention, most commonly duodenojejunostomy, provides durable symptom relief and significantly improves the quality of life. Persistent nausea may occur secondary to chronic gastric dysmotility resulting from prolonged obstruction. Early recognition is essential to reduce morbidity and psychological distress.
CONCLUSION: Based on the limited literature and current guidelines, duodenojejunostomy is the preferred surgical approach for SMAS, and it provides a better quality of life given the significant reduction of symptoms.
METHODS: A structured literature review was conducted and presented at the Society of the Alimentary Tract grand rounds, comparing limited studies done at different institutions to gain a better understanding. This study is a literature review and did not involve any human participants or animal subjects; therefore, ethical approval was not required.
RESULTS: Initial management is conservative and focuses on nutritional rehabilitation via nasojejunal or jejunostomy feeding to restore the mesenteric fat pad. When conservative measures fail, surgical intervention, most commonly duodenojejunostomy, provides durable symptom relief and significantly improves the quality of life. Persistent nausea may occur secondary to chronic gastric dysmotility resulting from prolonged obstruction. Early recognition is essential to reduce morbidity and psychological distress.
CONCLUSION: Based on the limited literature and current guidelines, duodenojejunostomy is the preferred surgical approach for SMAS, and it provides a better quality of life given the significant reduction of symptoms.