Diseases

Superior Mesenteric Artery Syndrome – Causes, Symptoms & Treatment

Arteria-mesenterica-superior-Syndrom

The superior mesenteric artery syndrome is a compression syndrome that leads to upper abdominal pain, difficult eating and nausea to the point of vomiting. Patients often suffer from malnutrition, which those around them often mistake for the consequences of an eating disorder. Treatment is primarily invasive and consists of decompression that allows normal feeding to be resumed.

What is Superior Mesenteric Artery Syndrome?

The superior mesenteric artery is better known as the superior visceral artery. It is a branch of the aorta that arises behind the neck of the pancreas between the renal arteries and the trunk of the celiac trunk. The origin is somewhat at the level of lumbar vertebrae 1. The arterial vessel can be affected by various vascular diseases.

One of these is what is known as superior mesenteric artery syndrome, also known as Wilkie syndrome , superior mesenteric artery syndrome , duodenal compression , or acute gastroduodenal obstruction . Equally common synonyms are the terms mesenteric duodenal compression syndrome , mesenteric root syndrome and chronic duodenal ailment .

Gastrointestinal vascular disease leads to duodenal stenosis, which occurs due to compression in the distal duodenal segment. This area lies between the superior mesenteric artery and the aorta. The main age at which the syndrome manifests is between ten and thirty-nine years of age. The prevalence is estimated at 0.3 percent in the general population. Women are affected far more often than men.

causes

The cause of the superior mesenteric artery syndrome is compression of the distal duodenal segment between the superior mesenteric artery and the aorta. This compression sometimes occurs most frequently during operations. At this point, scoliosis operations should be mentioned in particular, after which the syndrome is said to occur in around 2.4 percent of patients.

In addition, chronic weight loss appears to be a risk factor for compression disease. The syndrome is therefore often observed in the context of nutritional disorders. Other risk factors include anatomical abnormalities and pathological body processes with local limitations.

All of the risk factors mentioned have one connection in common, which can be described as the primary trigger of the superior mesenteric artery syndrome. The physiological angle between the aorta and the superior mesenteric artery is between 38 degrees and 56 degrees. If the angle between the two vessels decreases to six to 25 degrees due to the risk factors mentioned here, compression in terms of superior mesenteric artery syndrome can be expected.

Symptoms, Ailments & Signs

The superior mesenteric artery syndrome is associated with some clinically typical symptoms. For example, those affected often complain of pain in the upper abdomen , which occurs primarily after eating. In addition, patients experience a subjectively rapid feeling of satiety, which may result in weight loss.

In some of the documented cases, those affected even showed signs of malnutrition . Because of the pain they feel after eating, many sufferers often avoid eating and develop a real fear of eating. In isolated cases, symptoms ranging from nausea to vomiting were observed.

For this reason, the externally visible symptoms of the superior mesenteric artery syndrome often resemble an eating disorder . It can appear to observers as if the patient is suffering from binge eating or a similar disorder. Overall, superior mesenteric artery syndrome is associated with rather unspecific symptoms.

Diagnosis & History

Since the superior mesenteric artery syndrome has relatively unspecific symptoms and is also extremely rare, it is often difficult for the doctor to diagnose it. In many cases, the symptoms of the patients are traced back to a psychological cause over a long period of time, dismissed as an addiction or confused with other eating disorders.

This association is complicated by the fact that most patients with the syndrome are women. If a diagnosis takes place, imaging methods usually provide information as part of this diagnosis. The causal compression can be localized and identified via the imaging. It often takes at least a few months for imaging to be arranged. Many doctors are not familiar enough with the syndrome to consider its presence.

complications

The superior mesenteric artery syndrome has some clinical symptoms that clearly indicate the presence of this compression disorder. Those affected suffer from a congenital or acquired narrowing in the area of ​​the duodenum between the upper intestinal artery and the main artery. This narrowing is the cause of various health disorders, which severely restricts the quality of life of those affected.

Patients complain of upper abdominal pain, nausea, vomiting and difficult eating. This gastrointestinal vascular disease leads to a rapid feeling of satiety, which over a long period of time can cause visible weight loss and malnutrition. Due to the severe upper abdominal pain that occurs immediately after eating, many sufferers avoid eating or develop real feelings of anxiety about it.

Since superior mesenteric artery syndrome is associated with rather unspecific symptoms, eating disorders or addictive behavior are suspected in many cases. A differential diagnosis and the associated individual treatment are therefore delayed in many patients, which aggravates the complications and symptoms.

With appropriate treatment, there is a positive prognosis, because the compression syndrome can be remedied without risk through an invasive procedure. However, many patients develop postoperative psychosomatic complications when the disease has been present for a long time. This abnormal behavior manifests itself in an increased fear of eating, which caused excessive pain prior to surgery. However, with professional psychological support, these anxiety states can be successfully treated.

When should you go to the doctor?

Superior mesenteric artery syndrome should definitely be evaluated and treated by a doctor. This disease is not self-healing and, in the worst case, can lead to the death of the patient if no treatment is initiated.

A doctor should be consulted if food is refused due to severe abdominal pain. The patients can also suffer from a fear of eating and show symptoms such as vomiting or nausea. A doctor should be consulted in any case, especially in the event of a refusal to eat if you have a superior mesenteric artery syndrome.

It is not uncommon for the symptoms to resemble an eating disorder. The treatment should usually be initiated by a relative, since the patients themselves often cannot admit the complaint. In the case of psychological problems in particular, urgent treatment is necessary so that malnutrition does not lead to further complications or consequential damage.

In severe cases, the affected person must then be fed artificially via a stomach tube. In particular, the parents and partners of those affected must pay attention to symptoms and signs of superior mesenteric artery syndrome and, in any case, consult a doctor.

Treatment & Therapy

The treatment of superior mesenteric artery syndrome consists of causal treatment steps and symptomatic treatment measures. The resolution of the compression is one of the causal therapeutic steps. This decompression is usually done as part of an invasive procedure.

The symptomatic treatment steps are aimed at gaining weight. First, signs of malnutrition are compensated for by intravenous supplements. If the patient cannot bring himself to eat, a duodeno-jejunostomy can be performed, for example.

A jejunostomy is a surgical procedure in which a connection is made between the abdominal wall and the upper small intestine. The surgeon places an intestinal tube through the opening, through which enteral nutrition is secured. Jejunostomies can be surgical in the form of open or laparoscopic surgery. Interventional-endoscopic variants of the procedure are also available, such as jejunoscopy.

If the superior mesenteric artery syndrome has existed for a long time, psychotherapeutic or psychological care can be useful. Those affected often suffer from fear of eating because of the symptoms, even after a long period of time. This fear can be countered with professional support so that normal food intake is possible again and the weight that has been built up can be maintained naturally.

Outlook & Forecast

Superior mesenteric artery syndrome has a good prognosis. The difficulty of the disease lies in the diagnosis. The symptoms often lead to a confusion of the disease and thus lead to a greatly delayed start of treatment. If it starts too late, there may already be organ damage or functional disorders. These are mostly irreparable.

The course of the disease is progressive and in severe cases can lead to a breakdown of the system. If medical care is deliberately refused, the patient will lose weight further. Women are affected by the disease more often than men. Nevertheless, the disease takes the same course in both sexes.

Corrective surgery is performed as part of medical care. In this, the functionality of the vessel is restored. The patient must then be monitored for the purpose of controlled weight gain. Within a few months, the patient can normally be discharged as symptom-free.

A return of the symptoms is considered unlikely. Nevertheless, there can be various consequences of the experiences. In most cases, psychological problems arise that have to be treated after the physical treatment. A mental disorder is treated in psychotherapy . Relief of symptoms can take months or years.

prevention

The superior mesenteric artery syndrome can only be prevented to the extent that a reduction in the anatomical angle between the aorta and superior mesenteric artery can be prevented.

aftercare

In most cases, sufferers of superior mesenteric artery syndrome have very limited options for self-help. Patients typically require medical treatment to relieve and limit the symptoms of the syndrome. A complete cure cannot always be guaranteed, although in some cases there is also a reduced life expectancy due to the syndrome.

Superior mesenteric artery syndrome is usually treated surgically. Although this proceeds without complications, early diagnosis with timely treatment is crucial to prevent further symptoms. After such an operation, those affected must definitely rest and protect their bodies.

You should refrain from strenuous activities or sporting activities in order not to unnecessarily burden the body. Likewise, any stressful situation should be avoided. After the procedure, only light food may be eaten. Only over time does the body have to get used to normal food so that the person concerned can gain weight again. Furthermore, in the case of the superior mesenteric artery syndrome, contact with other sufferers of the syndrome can be useful, since this can lead to an exchange of information.

You can do that yourself

There are no self-help options for patients to treat the disorder causally. However, the disease is associated with chronic malnutrition. People who suffer from an eating disorder should therefore take countermeasures in good time with regard to the superior mesenteric artery syndrome and, if necessary, start therapy.

If malnutrition is caused by compression of the venous artery, it is important that those affected regain weight as soon as possible after surgery to correct the disorder. However, weight gain should not be caused by excessive consumption of unhealthy foods such as convenience foods, fatty meat, French fries or sweets.

Instead, those affected should have a diet plan put together by a dietary nutritionist that allows them to gain weight in a healthy way. Nuts and seeds, high-quality vegetable fats and oils and whole grain products are beneficial.

If there is a vitamin or mineral deficiency during the illness , these deficits can be quickly compensated for with dietary supplements.

Some patients develop a pathological fear of eating during illness because eating has historically been associated with severe pain. If this anxiety persists after the physical causes have been addressed, therapy should be considered. In many cases, however, appetite-stimulating substances already help to find a way back to normal eating habits.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.