Superior Mesenteric Artery Syndrome

Ans. is ‘d’ i.e., Most common in 6^th to 7^th decade 

Superior Mesenteric Artery syndrome or Wilkie’s syndrome

–                                                                  is a rare condition in which obstruction of the 3rd portion of duodenum is produced by compression between the superior mesenteric vessels and the aorta.

• Causes and pathophysiology

–                                          the superior mesenteric artery normally leaves the aorta at an acute angle (-50-60°). Normally a mass of fat and lymphatics around the origin of SMA is believed to protect the duodenum from compression.

• Factors that may precipitate obstruction are

sudden wt. loss following injury or bum

rapid growth in height.

–  application of body casts

–  supine immobilization

• Clinical picture

–  the syndrome is seen invariably in thin patients

– common in young adults, more common in females

• Symptoms include epigastric bloating and crampy pain after meals, relieved by vomitting or prone position.
• Investigation

– Barium meal study

Hypotonic duodenography is superior to barium meal

– CT scan with contrast

• Management
• Conservative t/t

– conservative t/t is successful in most cases associated with orthopedic condition. Treatment usually involves removal of plaster cast and mobilization of patient.

– Postural therapy : patient is advised to turn into prone or knee-elbow position after meals or when symptomatic.

• Surgery

–  for patients not responding to conservative methods

– duodenojejunostomy is done