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Tsikhan N.M.*, Volkava M.P.*, Khmialenka A.V.**, Hryn A.I.***
Superior mesenteric artery syndrome. Clinical case in pediatric practice
*Grodno State Medical University, Grodno, Republic of Belarus
**Grodno Regional Children’s Clinical Hospital, Grodno, Republic of Belarus
***Republican Research and Practical Centre for Pediatric Surgery, Minsk, Republic of Belarus

Vestnik VGMU. 2016;15(6):63-73.

The article is devoted to an unusual cause of duodenal obstruction – superior mesenteric artery syndrome (SMAS) which is characterized by a compression of the third part of the duodenum between the superior mesenteric artery and the abdominal aorta. SMAS incidence rate is not precisely known due to some difficulties in the diagnosis. There are not so many publications about clinical cases of SMAS that can be found in scientific literature and especially those from pediatric practice. Combination of SMAS with other gastroduodenal diseases can mask it and create difficulties in early diagnosis.
The etiology and mechanism of this syndrome development, clinical and diagnostic aspects and possible approaches to its management have been analyzed. We report a clinical case of SMA syndrome from our pediatric practice. This case demonstrates the diagnostic difficulties caused by the lack of specific clinical symptoms. However, the presence of the expressed clinical symptoms of duodenostasis and marked stomach distension may serve as a ground to exclude such a rare pathology as SMA syndrome. One of the most important directions in the diagnosing of SMA syndrome is the use of a computer tomography scan of the abdomen with combined contrasting of the stomach and the duodenum and computer angiography of the blood vessels. Combination of these methods enables clear visualization of the duodenum and vessels, estimation of the functional condition of the stomach and duodenum in order to choose the treatment tactics. Timely diagnosis will allow to avoid serious complications development and to get good treatment results. But it requires from specialists not only the knowledge about this issue, but also instrumental diagnosing facilities.
Key words: superior mesenteric artery syndrome, duodenal obstruction, computer tomography.


1. Shcherbinina MB, Gladun VN, Kozhan SI, Semashko AV, Feshchenko SI. Syndrome of the upper mesenteric artery. Suchasna gastroenterologіia. 2012;(5):76-82. (In Russ.)
2. Garapati S, Saritha S, Praveen Kumar M. Superior mesenteric artery syndrome. A case report. Int J Basic Med Sci. 2012;3(3):76-80.
3. Yakan S, Calıskan C, Kaplan H, Deneclı AG, Coker A. Superior Mesenteric Artery Syndrome: A Rare Cause of Intestinal Obstruction. Diagnosis and Surgical Management. Indian J Surg. 2013 Apr;75(2):106-10. 
4. Welsch T, Büchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg. 2007;24(3):149-56.
5. Wilkie D P D. Chronic duodenal ileus. Brit J Surg. 1921;9(34):204-14. doi:
6. Baltazar U, Dunn J, Floresguerra C, Schmidt L, Browder W. Superior mesenteric artery syndrome: an uncommon cause of intestinal obstruction. South Med J. 2000 Jun;93(6):606-8.
7. Lorentziadis ML. Wilke’s syndrome. A rare cause of duodenal obstruction. Ann Gastroenterol. 2011;24(1):59-61.
8. Tsimmerman YaS. The syndrome of chronic duodenal obstruction: modern view on the problem. Klin Meditsina. 2009;(10):9-16. (In Russ.)
9. Smith BG, Hakim-Zargar M, Thomson JD. Low body mass index – a risk factor for superior mesenteric artery syndrome in adolescence undergoing spinal fusion for scoliosis. J Spinal Disord Tech. 2009 Apr;22(2):144-8. doi:
10. Gubergrits NB, Lukashevich GM, Golubova OA, Fomenko PG. Chronic duodenal hypertension: etiology, pathogenesis, clinical features, diagnosis and treatment. Suchasna gastroenterologіia. 2010;(2):98-106. (In Russ.)
11. Lim JE, Duke GL, Eachempati SR. Superior mesenteric artery syndrome presenting with acute massive gastric dilatation, gastric wall pneumatosis, and portal venous gas. Surgery. 2003 Nov;134(5):840-3.
12. Federle MP, Jeffrey RB, Woodward PJ, Borhani A. Diagnostic imaging abdomen. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2010. 1274 p.
13. Unal B, Aktaş A, Kemal G, Bilgili Y, Güliter S, Daphan C, Aydinuraz K. Superior mesenteric artery syndrome: CT and ultrasonography findings. Diagn Interv Radiol. 2005 Jun;11(2):90-5.
14. Agrawal GA, Johnson PT, Fishman EK. Multidetector row CT of superior mesenteric artery syndrome. J Clin Gastroenterol. 2007 Jan;41(1):62-5.

Information about authors:
Tsikhan N.M. – Candidate of Medical Sciences, associate professor of the Chair of Childhood Diseases No. 1, Grodno State Medical University;
Volkava M.P. – Candidate of Medical Sciences, associate professor of the Chair of Childhood Diseases No. 2, Grodno State Medical University;
Khmialenka A.V. – head of the urgent surgery department, Grodno Regional Children’s Clinical Hospital;
Hryn A.I. – pediatric surgeon of the urgent surgery department, Republican Research and Practical Centre for Pediatric Surgery.

Correspondence address: Republic of Belarus, 230009, Grodno, 80 Gorky str., Grodno State Medical University, Chair of Childhood Diseases No. 1. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Tikhon Natalya M.

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