SMA Obstruction of Bowel

DEFINITION

Superior mesenteric artery obstruction of the intestine.
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EPIDEMIOLOGY

Rare
More common in women.
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AETIOLOGY

Pathogenesis
Compression of SMA on D3 --> obstruciotn
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BIOLOGICAL BEHAVIOUR

Pathophysiology

Most commonly after a period of weight loss, e.g. critical injury.
- acute fat loss drops artery posteriorly
SMA normally leaves aorta at 50-60 degrees
- down to 18 degrees in these patients --> squashed.

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MANIFESTATIONS

Symptoms

Epigastric bloating, crampy pain
Relieved by vomiting.


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INVESTIGATIONS

Imaging
Upper GI series shows wide duodeum, then a transition point.
Angiography shows an acute angle of SMA vs aorta (<25degrees).

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MANAGEMENT

Operative
Surgical mobilization of the duodenum, or bypass.
Mobilization of the DJ flexure can release congenital bands if present.
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REFERENCES
Doherty.