Ver el código de «Superior mesenteric artery syndrome»

<languages/>
<translate>

==Background==

*AKA: Wilke's syndrome 
*Rare condition, first described by Von Rokitansky in 1861 and then further studied in detail by Wilke in 1912
*Occurs when duodenum is compressed between aorta and superior mesenteric artery
*Can lead to gastrointestinal obstruction at level of duodenum
**Chronic, intermittent, or acute
**Partial or complete 
*Controversy over this diagnosis


===Etiology===

[[File:SMAAnatomy.JPG|thumb|Healthy SMA anatomy]]
*SMA takes off from the abdominal aorta at about 45 degree angle, due to cushioning from fatty/lymphatic tissue called mesenteric pad
*Third part of the duodenum courses between the angle formed
*Narrowing of this angle can cause entrap and compress of the duodenum 
*Factors that narrow this angle include:
**Significant weight loss (most common cause)
*Corrective spinal surgery for scoliosis lengthens the spine 
**Congenital defects, suggested genetic predisposition 
**Abdominal adhesions


==Clinical Features==

*Early satiety, belching, post-prandial bloating, weight loss
*[[Special:MyLanguage/Nausea and vomiting|Nausea and vomiting]], can be bilious 
*[[Special:MyLanguage/Abdominal pain|Abdominal pain]], mid-abdomen, may be improved with changes of position
*Proximal [[Special:MyLanguage/small bowel obstruction|small bowel obstruction]]


==Differential Diagnosis==

*See [[Special:MyLanguage/Abdominal Pain|Abdominal Pain]]
*See [[Special:MyLanguage/Nausea and vomiting|Nausea and vomiting]]


==Evaluation==

*Evaluate for alternative causes of symptoms and for complications
*Suspected based on signs and symptoms
*Diagnosis confirmed by imaging:
**Upper GI series
**Upper endoscopy 
**CT


==Management==

*Correct [[Special:MyLanguage/dehydration|dehydration]], [[Special:MyLanguage/electrolyte abnormalities|electrolyte abnormalities]], [[Special:MyLanguage/malnutrition|malnutrition]]
*Primary goal is to correct the underlying cause, typically regain lost weight
*Acute management:
**Adjusting body position to alleviate symptoms, such as knee to chest or lying on left side 
**[[Special:MyLanguage/Nasogastric tube|Nasogastric tube]] for decompression 
*Some patients may require a feeding tube distal to the obstruction or parenteral nutrition
*Surgery sometimes indicated
**Strong's procedure: duodenum moved to the right of the SMA
**Gastrojejunostomy, duodenojejunostomy


==Disposition==

*Depends on clinical presentation 
*If complete obstruction, admission for decompression and nutrition
*Outcome excellent with early diagnosis and appropriate treatment


==See Also==

*[[Special:MyLanguage/Acute gastric dilation|Acute gastric dilation]]


==External Links==


==References==

<references/>
*1. <Karrer FM. Superior Mesenteric Artery Syndrome. Medscape Reference. Jan 2017; http://emedicine.medscape.com/article/932220-overview.>
*2. <Pleoa A, Constantinescu C, Crumpei F, and Cotea E. Superior mesenteric artery syndrome: an unusual cause of intestinal obstruction. "J Gastrointest Liver Dis". Mar 2006; 15(1): 69-72.>
*3. <Lorentziadis M. Wilke's syndrome. A rare cause of duodenal obstruction. "Ann Gastroenterol." 2011; 24(1): 59-61.

[[Category:Vascular]] [[Category:GI]]
</translate>