Understanding SMA Syndrome

Superior Mesenteric Artery (SMA) Syndrome is a serious condition that affects the small intestine. While uncommon, it is a condition that we treat at The Cardiovascular Care Group. Understanding SMA Syndrome, its symptoms, causes, and treatment options can help patients and healthcare providers recognize and manage this challenging disorder effectively.

What is SMA Syndrome?

SMA Syndrome, also known as Wilkie’s Syndrome, occurs when the duodenum (the first section of the small intestine) becomes compressed between the superior mesenteric artery (SMA) and the abdominal aorta. This compression leads to an obstruction that can cause severe digestive issues. Unlike other gastrointestinal conditions, SMA Syndrome is caused by vascular and anatomical factors rather than by infection or inflammation.

What Causes SMA Syndrome?

The condition is primarily caused by a decrease in the angle between the SMA and the aorta, which reduces the space for the duodenum. This narrowing can be triggered by factors such as:

• Significant weight loss (due to illness, eating disorders, or surgery)
• Congenital anatomical variations
• Spinal conditions (such as scoliosis correction or rapid post-surgical weight loss)
• Prolonged bed rest causing muscle atrophy and fat loss around the artery

Symptoms of SMA Syndrome

Symptoms of SMA Syndrome can vary in severity, but common signs include:

• Persistent nausea and vomiting
• Abdominal pain, especially after eating
• Bloating and early satiety (feeling full after a small amount of food)
• Significant weight loss
• Malnutrition and dehydration

Due to the overlap in symptoms with other gastrointestinal disorders, SMA Syndrome is often misdiagnosed as gastroparesis, peptic ulcer disease, or other functional digestive disorders.

Diagnosing SMA Syndrome

A combination of imaging studies and clinical evaluation is necessary to diagnose SMA Syndrome. Common diagnostic tools include:

• CT scan or MRI to assess the SMA angle and duodenal compression
• Upper GI series (barium swallow test) to observe obstruction
• Ultrasound or Doppler studies to evaluate blood flow through the SMA

Treatment Options

The approach to treating SMA Syndrome depends on the severity of symptoms and the underlying cause. Treatment options include:

Conservative Management

• Nutritional support: Increasing caloric intake to regain weight and restore fat padding around the artery
• Enteral feeding (feeding tube) for patients unable to eat sufficiently
• Postural adjustments: Eating in specific positions (such as lying on the left side or in a knee-chest position) to reduce compression

Surgical Intervention

For patients with severe or persistent symptoms that do not improve with conservative treatment, surgical options may be necessary. These include:

• Duodenojejunostomy: Creating a bypass around the compressed duodenum
• Gastrojejunostomy: Rerouting the stomach contents to the jejunum (a different section of the small intestine)
• Strong’s Procedure: Repositioning the SMA to relieve compression

Why Early Diagnosis Matters

Delays in diagnosing SMA Syndrome can lead to severe malnutrition, dehydration, and long-term digestive complications. If you or someone you know has persistent gastrointestinal symptoms that do not respond to typical treatments, it is essential to seek evaluation by a specialist. At The Cardiovascular Care Group, we provide expert diagnosis and treatment options to help patients manage this condition effectively.

If you have questions about SMA Syndrome or need to schedule an evaluation, contact our team today.