Anatomy and Physiology of the Superior Mesenteric Artery
The superior mesenteric artery is a large artery located in the stomach or abdominal cavity. It originates from the abdominal aorta (largest artery in the abdominal cavity) and crosses over the first part of the small intestine called the duodenum. It has several branches and its primary functions include providing blood to small intestine, cecum (first part of the large bowel), and large intestine.
History/Definition of Superior Mesenteric Artery Syndrome
Superior mesentery artery syndrome was first described in a 1842 textbook authored by Austrian scientist, Carl von Rokitansky. It is a rare disease in which the superior mesentery artery blocks the duodenum as it crosses over it. It is thought that many physicians may not be familiar with this syndrome and that many patients go undiagnosed or misdiagnosed for long periods of time.
In the general population in the United States, the prevalence of superior mesenteric artery syndrome is very low (0.013-0.3%). In addition, females are more likely than males to develop this syndrome. Approximately two-thirds of those affected are between the ages of 10 and 39 years old.
Several factors may contribute to the development of this syndrome. They include but are not limited to:
- Long periods of bed rest
- Weight loss
- Wearing body casts
- Loss of abdominal muscle tone
- Abdominal surgery
Some of the symptoms of superior mesenteric artery syndrome are listed below. This is not meant to be an all-inclusive list but rather a list of some of the most common symptoms.
- Difficulty gaining weight
- Weight loss
- Enlarged lymph nodes
- Pain in the abdomen
- Stomach cramps
- Outward curvature of the spine (rounded back)
- Inward curvature of the spine
- Tumors in the abdominal cavity
- Abnormal rotation of the intestines
Diagnosis of Superior Mesenteric Artery Syndrome
Confirming a diagnosis of mesenteric artery syndrome can be challenging. Some of the diagnostic procedures are provided below:
- CT scan used to measure any superior mesenteric artery or duodenal distension or presence of intra-abdominal fat
- Gastrointestinal endoscopy (use of a lighted, flexible tube to evaluate body organs such as the esophagus, stomach, intestines) to assess any mechanical blockages in the duodenum
- Abdominal ultrasound to assess the angle at which the superior mesenteric artery crosses the duodenum
Treatment for superior mesenteric artery syndrome includes intravenous and oral fluids in the blocked area and decompression of duodenum. Tube feeding is also sometimes used if the syndrome results in weight loss. Drugs such as Reglan are also used to increased motility in the gastrointestinal area. Surgical intervention is usually a last resort and may not always be successful.
Thilo Welsch, Markus W. Büchler, Peter Kienle. Recalling Superior Mesenteric Artery Syndrome. Digestive Surgery 24(3), 2007.
National Institutes of Health. Office of Rare Diseases Information Center. Superior mesenteric artery syndrome. https://rarediseases.info.nih.gov/GARD/Condition/7712/QnA/21583/Superior_mesenteric_artery_syndrome.aspx.