Superior mesenteric artery syndrome is a compression syndrome that results in upper abdominal pain, difficulty eating, and nausea and even vomiting. Patients often suffer from malnutrition, which is often mistaken by those around them for the effects of an eating disorder. Treatment is primarily invasive and consists of decompression to restore normal food intake.
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 originates behind the neck of the pancreas between the renal arteries and the trunk of the coeliac trunk. The origin is somewhat at the level of lumbar vertebra 1. The arterial vessel may be affected by various vascular diseases. One of these is the so-called superior mesenteric artery syndrome, also known as Wilkie syndrome, superior mesenteric artery syndrome, duodenal compression, or acute gastroduodenal obstruction. Equally common synonyms include the terms mesenteric duodenal compression syndrome, mesenteric root syndrome, and chronic duodenal ulcer. Gastrointestinal vascular disease results in duodenal stenosis based on compression in the distal duodenal segment. This area is located between the superior mesenteric artery and the aorta. The main age of manifestation of the syndrome is between the ages of ten and 39 years. The prevalence is estimated at 0.3 percent in the normal population. Women are affected far more often than men.
Causes
The cause of superior mesenteric artery syndrome is compression of the distal duodenal segment between the superior mesenteric artery and the aorta. This compression occurs most commonly during surgery. In this regard, scoliosis surgery is most notable, after which the syndrome is reported to occur in approximately 2.4 percent of patients. In addition, chronic weight loss appears to be a risk factor for the compression disorder. Accordingly, the syndrome is frequently observed in the context of nutritional disorders. Other risk factors include anatomic abnormalities and pathological body processes with local limitation. Common to all of the above risk factors is a relationship that 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. When the angle between the two vessels is reduced to six to 25 degrees because of the risk factors mentioned here, compression in the sense of superior mesenteric artery syndrome is to be expected.
Symptoms, complaints, and signs
Superior mesenteric artery syndrome is associated with some clinically typical symptoms. For example, affected individuals often complain of pain in the upper abdomen, which occurs preferentially after eating. In addition, patients experience what is subjectively perceived as a rapid feeling of fullness, which may result in weight loss. In some of the documented cases, the patients even showed signs of malnutrition. Due to the perceived pain after eating, many of the sufferers often practice food avoidance and develop a real fear of eating. In individual cases, symptoms such as nausea and even vomiting have been observed. For this reason, the outwardly apparent symptoms of superior mesenteric artery syndrome often resemble an eating disorder. To observers, it may appear as if the patient is suffering from binge eating or a similar disorder. Overall, mesenteric superior artery syndrome is associated with a rather nonspecific symptomatology.
Diagnosis and course
Because superior mesenteric artery syndrome entails relatively nonspecific symptomatology and, moreover, is extremely rare, physicians often have difficulty making a diagnosis. In many cases, patients’ complaints are attributed to a psychological cause over a long period of time, dismissed as an addictive disorder or confused with other eating disorders. This connection is complicated by the fact that the patients of the syndrome are mostly women. If a diagnosis is made, imaging techniques are usually used to provide information. Imaging allows the causative compression to be localized and identified.It often takes at least several months before imaging is ordered. Many physicians are too unfamiliar with the syndrome to consider its presence.
Complications
Superior mesenteric artery syndrome has some clinical symptoms that clearly indicate the presence of this compression disorder. Affected individuals suffer from congenital or acquired narrowing in the duodenal region between the superior iliac artery and the aorta. This narrowing is the cause of various health disorders that severely limit the quality of life of those affected. Patients complain of upper abdominal pain, nausea, vomiting and difficult food intake. This gastrointestinal vascular disease leads to a rapid feeling of satiety, which can cause visible weight loss and malnutrition over a prolonged period of time. Because of the severe upper abdominal pain that occurs immediately after eating, many sufferers avoid eating or develop a real fear of eating. Since superior mesenteric artery syndrome is associated with rather nonspecific symptoms, eating disorders or addictive behavior are also suspected in many cases. A differential diagnosis and the associated individual treatment are therefore delayed in many patients, which exacerbates the complications and symptoms. With appropriate treatment, there is a positive prognosis because invasive surgery can correct compression syndrome without risk. However, many patients develop postoperative psychosomatic complications when the condition has been present for a long time. This abnormal behavior manifests itself in increased fear of food intake, which caused excessive pain before surgery. However, with expert psychological guidance, these anxiety states can be successfully treated.
When should you see a doctor?
Superior mesenteric artery syndrome should definitely be examined and treated by a doctor. This disease does not lead to self-healing and, in the worst case, the patient may die if treatment is not initiated. A doctor should be consulted if food intake is refused due to severe pain in the abdomen. In this case, patients may also suffer from a fear of food and present with symptoms such as vomiting or nausea. Especially in case of food refusal, a doctor should be consulted in any case of arteria mesenterica superior syndrome. Not infrequently, the symptoms also resemble an eating disorder. In this case, treatment should usually be initiated by a relative, since patients themselves are often unable to admit to the complaint. Urgent treatment is necessary, especially in the case of psychological complaints, so that the malnutrition does not lead to further complications or consequential damage. In severe cases, the affected person must then be artificially fed via a stomach tube. Above all, the parents and partners of the affected person must pay attention to symptoms and signs of superior mesenteric artery syndrome and consult a physician in any case.
Treatment and therapy
Treatment of superior mesenteric artery syndrome is composed of causative treatment steps and symptomatic treatment measures. Decompression is among the causal therapeutic steps. This decompression is usually performed as part of an invasive procedure. The symptomatic treatment steps are aimed at building up weight. Initially, malnutrition symptoms are compensated via intravenous supplements. If patients cannot bring themselves to eat, a duodeno-jejunostomy, for example, may be performed. A jejunostomy is a surgical procedure in which a connection is made between the abdominal wall and the upper small intestine. Through the opening, the surgeon places an intestinal tube through which enteral nutrition is secured. Jejunostomies can take place surgically 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 persisted for an extended period of time, psychotherapeutic or psychological care may be appropriate. Often, those affected suffer from fear of food intake due to the symptoms, even after a longer period of time.This fear can be countered with professional guidance so that normal food intake can be restored and the rebuilt weight can be maintained naturally.
Outlook and prognosis
Superior mesenteric artery syndrome has a good prognostic outlook. The difficulty of the disease is in making the diagnosis. Symptoms often lead to confusion of the disease, causing a severely delayed onset of treatment. If it starts too late, organ damage may already be present or functional disorders may be present. 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 continue to lose weight. Women are more commonly affected by the disease than men. Nevertheless, the disease takes the same course in both sexes. Within medical care, a corrective intervention is performed. In this, the functionality of the vessel is restored. Subsequently, the patient must be cared for for the purpose of controlled weight gain. Within a few months, the patient can normally be discharged as symptom-free. A return of symptoms is considered unlikely. Nevertheless, various sequelae may result from the experience. In most cases, psychological problems arise that must be treated following the physical treatment. A psychological disorder is treated in psychotherapy. Alleviation of symptoms may take months or years.
Prevention
Superior mesenteric artery syndrome can be prevented only to the extent that a reduction in the anatomic angle between the aorta and the superior mesenteric artery can be prevented.
Follow-up
In most cases of superior mesenteric artery syndrome, affected individuals have very limited options for self-help. Patients usually rely on medical treatment to relieve and limit the symptoms of the syndrome. A complete cure cannot always be guaranteed, and in some cases there is also a reduced life expectancy due to the syndrome. Superior mesenteric artery syndrome is usually treated by surgery. This proceeds without complications, but early diagnosis with timely treatment is critical to prevent further symptoms. After such an operation, affected persons must in any case rest and take care of their body. Strenuous activities or sporting activities should be avoided in order not to put unnecessary strain on the body. Likewise, any stressful situation should be avoided. After the operation, only light food should be taken. Only with time must the body become accustomed to ordinary food, so that the affected person can also regain weight. Furthermore, in the case of the arteria mesenterica superior syndrome, contact with other sufferers of the syndrome can be useful, as this can lead to an exchange of information.
Here’s what you can do yourself
There are no self-help options for patients that treat the disorder causally. However, the disorder is associated with persistent malnutrition. Individuals suffering from an eating disorder should therefore also take timely countermeasures with regard to superior mesenteric artery syndrome and, if necessary, begin therapy. Provided that the malnutrition was first triggered by the compression of the visceral artery, it is important that the affected persons regain weight as soon as possible after the surgical intervention to eliminate the disorder. However, weight gain should not come from excessive consumption of unhealthy foods such as convenience foods, fatty meats, French fries or sweets. Instead, sufferers should have an ecotrophologist put together a diet plan that allows for healthy weight gain. Nuts and seeds, high-quality vegetable fats and oils, and whole grains are beneficial. If vitamin or mineral deficiencies have occurred during the illness, these deficiencies can be made up quickly with nutritional supplements. Some patients develop a pathological fear of eating during illness, as food intake was associated with severe pain in the past.If these anxiety states persist after the physical causes have been eliminated, therapy should be considered. In many cases, however, appetite stimulants are already helpful in returning to normal eating patterns.
