UNASSIGNED: This study examines aortomesenteric angle (AMA) and distance (AMD), which are critical in superior mesenteric artery (SMA) syndrome. Addressing the scarcity of SMA cases, the research explores potential links with lower BMI and aims to establish normative data for diagnostic and predictive purposes, using contrast-enhanced computed tomography (CT) scans across various BMI and sex categories.
UNASSIGNED: A retrospective quantitative cross-sectional study was conducted on 189 patients undergoing abdominal contrast-enhanced CT scans between December 2019 and December 2020. Ethical clearance was obtained, and participants provided informed consent. Exclusion criteria targeted specific medical histories. Patient demographics, BMI categories, and imaging data were recorded. Helical 128-slice CT scans were employed, with sagittal-oblique multiplanar reconstructions for parameter assessments. Statistical analysis utilized SPSS 26.0, including Pearson correlation coefficients and mean calculations.
UNASSIGNED: The study reveals a mean AMA of 54.07°±8.53° and a mean distance of 16.25±3.44 mm. Elevated BMI is found to positively correlate with AMA and distance, indicating that higher BMI values may augment these parameters, with an additional positive correlation observed between AMA and distance. No significant correlations are found with patient age or sex.
UNASSIGNED: The study concludes that decreased BMI may pose a potential risk for SMA syndrome, as evidenced by the observed correlations with aortomesenteric parameters. Understanding these normal values in the Nepalese population is critical for accurate diagnoses and predictions using CT scans. The research highlights the impact of demographic factors on these parameters and emphasizes their significance in clinical assessments related to SMA syndrome.

OBJECTIVE: There are only a few case reports of laparoscopic lateral duodenojejunostomy (LLDJ) in children with Wilkie\'s syndrome, also known as superior mesenteric artery compression syndrome (SMAS). We aimed to describe our laparoscopic technique and evaluate its outcomes for SMAS in children.
METHODS: From January 2013 to May 2021, SMAS children who received LLDJ were included. The procedure was carried out utilizing the four-trocar technique. The elevation of the transverse colon allows good exposure of the dilated and bulging second and third sections of the duodenum. Using a linear stapler, we established a lateral anastomosis connecting the proximal jejunum with the third part of the duodenum. Following that, a running suture was used to intracorporeally close the common enterotomy. Clinical data on patients was collected for analysis. The demographics, diagnostic findings, and postoperative outcomes were analyzed retrospectively.
RESULTS: We retrospectively analyzed 9 SMAS patients (6 females and 3 males) who underwent LLDJ, aged between 7 and 17 years old. The mean operative time was 118.4 ± 16.5 min and the mean estimated blood loss was 5.6 ± 1.4 ml. There were no conversion, intraoperative complications or immediate postoperative complications. The mean postoperative hospital stay was 6.8 ± 1.9 days and the mean follow-up time was 5.4 ± 3.0 years. During follow-up, seven patients (77.8%) experienced complete recovery of symptoms prior to surgery. One patient (11.1%) still had mild vomiting, which resolved with medication. Another patient (11.1%) developed psychological-induced nausea, which significantly improved after treatment with education, training and diet management.
CONCLUSIONS: LLDJ represents a feasible and safe treatment option for SMAS in well-selected children. Further evaluation with more cases and case-control studies is required for the real benefits.

Superior mesenteric artery (SMA) syndrome is related to the reduction of the aortomesenteric angle on detailed imaging studies; i.e., an expert\'s ultrasonography or angiography. We aimed to test a simpler imaging finding of SMA syndrome. This cross-sectional case-reference study examined whether right movement of the SMA on unenhanced computed tomography (CT) is useful for the diagnosis of SMA syndrome. We reviewed hospital records of patients admitted in 2008-2018. Each case was matched to one non-case patient of the same age and sex. On unenhanced CT scans, we identified the shortest distance between the parallel line that passes through the center of the aorta to the line that bisects the spine and SMA. A negative number of the distance means that the SMA is on the left side of the above-described parallel line. There was a total of 14 cases and 14 non-cases (men, 57.1%) with mean age 78.7 years. Mean body mass index of cases and non-cases were 19.2 and 22.2 kg/m2 , respectively. The more prevalent side of the SMA was the right side. The mean shortest distance was 10.5 mm in cases and 0.7 mm in non-cases (p for independent t test = 0.043). For comparing the observations in SMA cases at several time points, the mean shortest distance at pre-onset was -2.7 mm, with a significant difference from that at onset (p for paired t test = 0.030). In conclusion, right movement of the SMA diagnosed by unenhanced CT is associated with SMA syndrome.

BACKGROUND: The diagnosis of the superior mesenteric syndrome depends on measuring the distance and angle between the superior mesenteric artery (SMA) and aorta on CT scan in the presence of duodenal compression. Studies examining the normal range of these measurements are scarce and none of them was conducted on the Iraqi population. The aim of this study was to assess the values of aorto-SMA angle (AMA) and aorto-SMA distance (AMD) in asymptomatic patients to define the normal range in the Iraqi population and to compare it with the normal published range and different demographical values and body mass index (BMI).
METHODS: A total of 333 patients referred to arterial phase CT examinations for reasons unrelated to gastrointestinal tract were recruited. On axial and reformatted sagittal-oblique images, the angle and the distance between SMA and aorta were measured at the location where the duodenum crosses.
RESULTS: Both AMA and AMD had a wider range 10-147° and 4-44 mm, respectively, compared to the literature reported range. There was a significant reduction in AMA and AMD values in underweight participants (AMA, P < 0.001; and AMD, P = 0.014) and in female patients (AMA and AMD, P < 0.0001) and those who were younger than 20 (AMA, P = 0.014; and AMD, P = 0.001). A moderate correlation (r = 0.507, P < 0.0001) was found between AMA and AMD values. The correlation of BMI with AMD values was moderate (r = 0.46), and with AMA was weak (r = 0.23) (P < 0.0001).
CONCLUSIONS: Very low values of AMA and AMD can occur in normal asymptomatic patients without compressing the duodenum, which warrants further follow-up studies. Evaluating normal values of AMA and AMD in the Iraqi population can help in providing a reference for CT-based diagnosis of SMA syndrome.

Post-operative nausea and vomiting (PONV) is often encountered following corrective scoliosis surgery in children, frequently attributed to high-dose opiate administration. PONV is a frequent cause of prolonged hospital stay. Mechanisms related to transient partial duodenal compression by narrow angulation of the superior mesenteric artery (SMA) and aorta following scoliosis surgery are poorly understood and might be implicated in PONV. This study investigates relationships between biomechanical anatomic variations of the SMA and aorta, and its relationship with clinically significant PONV following scoliosis surgery in children.
Children undergoing elective spinal arthrodesis for adolescent idiopathic scoliosis were assessed by preoperative abdominal ultrasound and spinal X-ray prior to surgery. Post-operative assessment of clinically significant PONV is compared to preoperative imaging and clinical variables.
Thirteen patients (11 female and two male), with a mean age of 14 years and 1 month were included. Five patients (38.5%) developed clinically significant PONV. A significant association was observed between the coronal aorto-mesenteric orientation and PONV (P = 0.035). Of the five patients who developed PONV, two had direct coronal angulation of the SMA, one had left angulation and two had right angulation. Patients with significant PONV had narrower aorto-mesenteric distances which approached significance (P = 0.06). No other preoperative variable reached significance.
Patients with coronal aorto-mesenteric orientation preoperatively appear at greater risk of developing significant PONV following scoliosis surgery, independent of opiate requirements, prompting consideration of transient partial duodenal obstruction as an important factor in the mechanisms of PONV. A coronal aorto-mesenteric orientation theory (CAMOT) is proposed to explain this biomechanical vascular \'scissor\'.

Introduction Superior mesenteric artery (SMA) or Wilkie\'s syndrome is a rare condition arising due to compression of the third part of the duodenum between the abdominal aorta and the superior mesenteric artery. It is important to explore factors which help in suspicion and early diagnosis of the condition. The aim of this study was to find out if measurements of aortomesenteric angle and distance can predict the occurrence of SMA syndrome. Another objective was to find out if the BMI was correlated with the aortomesenteric angle and distance of the patients. Methods A retrospective hospital-based case-control study was conducted in Qimat Rai Gupta Central hospital, Haryana, India from 2018-2020. Out of total 2100 records of acute and chronic abdominal pain patients, only seven cases of Wilkie\'s syndrome were confirmed via Contrast-Enhanced Computed Tomography (CECT). Information on age, gender, BMI, duration of symptoms, clinical presentation, aortomesenteric angle, and distance was compared among three groups: Group I-SMA syndrome patients (N=7), Group II- acute abdominal pain patients (N=14) and Group III- chronic abdominal pain patients (N=14). Results The hospital prevalence of Wilkie\'s was found to be 0.3%. The median age of patients in Group I corresponded to 26 years as opposed to Group II (31.5years) and Group III (30.5 years). There was a statistically significant reduction in the aortomesenteric angle and distance of Group I patients (22º, 6mm) as compared to both Group II (52.5º, 11mm) and Group III patients (52º, 11mm). A moderate correlation of BMI was found with aortomesenteric angle (r=0.479) and distance (r=0.357). Conclusions There was a significant reduction in the aortomesenteric angle and distance of the SMA patients as compared to both patients having acute and chronic abdominal pain. The BMI of patients was positively correlated to aortomesenteric angle and distance to the moderate level. Thus BMI along with aortomesenteric angle and distance can predict the presence of SMA syndrome.

Superior mesenteric artery syndrome (SMAS) is a relatively rare cause of chronic duodenal obstruction, owing to the compression of the third portion of the duodenum.
This retrospective study aims to discuss the efficacy of enteral nutrition (EN) therapy in nutritional status and symptom improvement at a short-term follow-up for SMAS patients.
We retrospectively analyzed clinical data of patients diagnosed as SMAS and treated with EN from September 2012 to January 2019.
Twenty-six patients were included (16 women; mean age 24.96 ± 11.77 years), none was excluded, and one was lost to follow-up. The patients\' mean body weight was 40.94 ± 10.16 kg, mean weight loss 11.73 ± 7.58 kg, and mean body mass index (BMI) 14.82 ± 2.52 kg/m2. The mean duration of EN therapy was 10.10 ± 4.66 months. Serum level of nutritional indicators, BMI and body weight increased after EN therapy. During a median follow-up of 24 months (9-44) after EN therapy, the mean symptom score decreased from 24.28 ± 9.57 to 8.06 ± 8.29 (p < 0.0001), and 65% of patients\' symptoms resolved and 15% of patients\' symptoms improved. In total, 16 complications occurred, including tube blockage, peristomal wound infections, peristomal leakage, granulomas, and nasopharyngeal pain.
EN therapy may be an effective option for SMAS patients. While it might not remove all symptoms, it can improve the nutritional status to support subsequent treatments.

Background: Eating disorders (EDs) are serious and life-threatening mental diseases characterized by abnormal or altered eating habits. The prevalence is variable, being influenced by diverse sociocultural factors. Historically, the prevalence of EDs has been higher in women (90%), although the incidence of these disorders in men appears to be increasing. In daily medical practice, when considering the presentation of other medical complications associated to the development of an ED, few is known about its real prevalence in men. Among them, some severe gastrointestinal complications that are rarely presented, such as the superior mesenteric artery syndrome (SMAS), can produce life-threatening results. Despite that, very few cases of men presenting this pathology are reported in literature. Case Presentation: A 38-year-old man without a history of psychiatric disease was admitted to the emergency department with nausea, abdominal pain, and severe malnutrition (body mass index 15.7 kg/m2). He was diagnosed with SMAS and was studied by multiple specialists on suspicion of a probable organic origin of his thinning. The suspected diagnosis of ED was rejected for months by some professionals, as well as by the patient and his family, until it was finally diagnosed with unspecified feeding and eating disorder (USFED). Conclusion: This case represents an example of diagnostic challenge where a delayed diagnosis of an ED in a male patient was made probably due to gender bias in clinical research and practice. In the literature, numerous reports were described in women diagnosed with SMAS with a previous diagnosis of an ED; however, few cases were found in men. In this clinical case, the patient suffered a significant diagnostic delay, probably due to the lack of diagnostic suspicion given by the differences in the prevalence and clinical presentation of EDs in women and men.

Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction, resulting from the compression of the duodenum between superior mesenteric artery and aorta. This prospective registry aims to describe demographic, clinical, and outcome features of patients suffering from SMAS and to point out the indications for surgery.
Between 2008 and 2016, patients with chronic gastrointestinal symptoms and diagnosis of SMAS were included. Demographics, clinical presentation, diagnosis, and surgical outcome were recorded. Symptoms were investigated with a standardized questionnaire. The diagnosis was achieved through barium swallow, CT/MR angiography (aortomesenteric angle ≤ 22°, distance ≤ 8 mm), endoscopy. All patients underwent duodenojejunostomy ± distal duodenum resection. At follow-up, symptom score and barium swallow were re-evaluated.
Thirty-nine patients (11 M/28 F, median age 38 years, median BMI 17.8 kg/m2) were included. Barium swallow showed a gastroduodenal dilation in 57% of patients, and a delayed gastroduodenal emptying in 38%. Median aortomesenteric angle was 11° and distance was 5 mm. All patients underwent duodenojejunostomy, and in 32 patients, a distal duodenum resection was also performed. At a median follow-up of 47 months, the overall symptom score significantly dropped (10 vs. 32, p < 0.0001) and BMI increased (19.5 vs. 17.8, p < 0.0001). Barium swallow at 2 months postoperatively showed an improvement in terms of gastroduodenal dilation and emptying in 38% of patients with preoperative pathological findings.
SMAS is a rare condition that should be suspected in cases of chronic, refractory upper digestive symptoms, particularly in females with low BMIs. Surgical treatment may improve symptoms and quality of life, although it is not curative in all cases. ClinicalTrials.gov Identifier: NCT03416647.

OBJECTIVE: Superior mesenteric artery (SMA) syndrome may occur in patients with constipation, whereas the association between these two distinct diseases has not been confirmed yet. We investigated the incidence, risk factors and treatment strategy associated with SMA syndrome in constipated patients.
METHODS: We conducted a prospective nested case-control study from a 9-year hospitalization cohort (n=973). Cases were matched to controls 1:4 on factors of age and gender. Cases developed SMA syndrome in long term follow-up (n=26) and controls did not (n=104). Independent risk factors were identified by using univariate analysis and conditional logistic regression analysis. Enteral nutritional support was applied in all cases and its curative effect was evaluated by retrospective analysis.
RESULTS: The incidence of SMA syndrome was 2.67%. The risk factors under scrutiny were body mass index (BMI)≤18 (odds ratio (OR) 2.89, 95% CI 1.14 to 9.31) and abnormal colon transit time (OR 3.57, 95% CI 1.36 to 9.35). Twenty-two patients recovered after treatment of nutritional support, and the success rate of conservative treatment was 84.6%.
CONCLUSIONS: BMI≤18 and prolonged colon transit time both were risk factors associated with SMA syndrome in constipated patients. Enteral nutritional support should be adopted as the first-line treatment for this condition.