Nota Clínica

The two sides of superior mesenteric artery syndrome treatment: conservative or surgical management?

Elvia Johanna Osegueda De Rodríguez, Antonio Carlos Hernández-villegas, Aurora Elizabeth Serralde-zúñiga, Ana Luz Del Carmen Reyes-ramírez

Introduction: Superior mesenteric artery syndrome (SMAS) is a rare condition characterized by vascular compression of the duodenum. There is controversy regarding the optimal treatment.Case report: In case 1, we describe the case of a 21-year-old woman (body mass index [BMI] 16.9 kg/m2) with high-level obstructive symptoms three months prior, with computed tomography scan (TC) showing a superior mesenteric artery aorta angle (SMAA) of 13° and compression of the third portion of the duodenum (D3), for this reason a nasojejunal tube was placed for enteral feeding. In case 2, enteral nutrition was initiated for feeding a 17-year-old female with anorexia nervosa (BMI 8.3 kg/m2). She presented macrohematuria, vomiting, epigastralgia, abdominal distension and acute abdomen when oral feeding was reinitiated. TC reported a SMAA of 15°, in addition to compression of the left renal vein (Nutcracker syndrome) and gastro duodenal expansion, surgical management was necessary.Discussion: Both cases had favorable evolution, being the nutritional support fundamental. SMAS should be suspected in all people with high-level obstructive symptoms and recent weight loss.

Palabras Clave: Mesenteric clamp. Superior mesenteric artery syndrome. Obstructive symptoms. Nutritional support. Surgical treatment.

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