31 August 2020 The superior mesenteric artery syndrome, or Wilkie syndrome, was first reported in the 19 th century and the first description of its surgical resolution dates from the beginning of the 20 th century. This disease is caused by a compression of the small intestine (in the duodenum) that causes its total or partial obstruction, sometimes intermittently. This compression is of vascular origin and the vessels involved are the superior mesenteric artery and the aorta. The superior mesenteric artery syndrome is a rare disease, which affects mainly adolescents and young adults, especially women. What are the causes of superior mesenteric artery syndrome? The small intestine (in the region of the duodenum) passes through the angle formed by the superior mesenteric artery and the aorta (aortomesenteric angle). Under normal conditions, the superior mesenteric artery is involved in its origin by adipose tissue (fat), which contributes to the maintenance of the aortomesenteric angle amplitude and not compressing the intestine. Any situations that cause a decrease in the amplitude of that angle can predispose to the occurrence of the superior mesenteric artery syndrome, in which the superior mesenteric artery and the aorta, like the arms of a clamp, compress the intestine. The most common situation that can cause a decrease in the amplitude of the aortomesenteric angle is a pronounced and rapid weight loss , which decreases the fat that surrounds the origin of the superior mesenteric artery, for example in cases of: Psychological problems, namely eating disorders; Surgeries that cause fat depletion and, therefore, decrease the aortomesenteric angle; Debilitating disorders or diseases that interfere with the absorption of nutrients. Other causes described are individual congenital or acquired anatomical variations, and an increase in height not accompanied by an adequate increase in body weight. How is the diagnosis made? Often several years pass before the superior mesenteric artery syndrome is diagnosed because the symptoms are not specific, the symptoms can be intermittent and are common to many other, much more common diseases. Symptoms include, for example, pain in the stomach after meals, nausea, vomiting, feeling full quickly after starting meals, lack of appetite and weight loss. Pain relieve with changes in posture, for example by flexing the trunk over the lower limbs, pulling the knees towards the chest or lying on the side, because these positions increase the amplitude of the aortomesenteric angle. Some imaging tests may be able to identify changes associated with symptoms, and suspicion allow the diagnosis of the disease . When all the remaining clinical investigation is not clear, an exploratory laparoscopy can make a decisive contribution to the diagnosis. How is superior mesenteric artery syndrome treated? Whenever possible, treatment is started with a conservative approach with interventions (for example, food interventions) that aim to restore adipose tissue to the level of the aortomesenteric angle, allowing its opening and eliminating duodenal compression with the consequent relief of symptoms. Surgical treatment is an option resulting from the failure of conservative treatment or the recurrence of symptoms. In this surgery, the portion of the small intestine that is affected is removed. Meet the general surgery team of Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
