From the Research
The management of superior mesenteric artery (SMA) syndrome should begin with conservative treatment focused on nutritional support and weight gain to increase the aortomesenteric angle and distance, and if conservative measures fail, laparoscopic duodenojejunostomy is a safe and effective surgical option. The initial management includes small, frequent meals with a high-calorie, high-protein diet in a left lateral or prone position after eating to facilitate passage of food through the compressed duodenum. Nutritional support may require nasojejunal tube feeding that bypasses the obstruction or parenteral nutrition in severe cases. Prokinetic agents like metoclopramide (10 mg three times daily before meals) may help improve gastric emptying. Conservative management should be attempted for 4-6 weeks before considering surgery, as suggested by 1.
Some key points to consider in the management of SMA syndrome include:
- The importance of early diagnosis and intervention, as highlighted by 2
- The role of laparoscopic duodenojejunostomy as a safe and effective surgical option, as demonstrated by 1 and 3
- The need for a multi-specialty team approach, including gastrointestinal, vascular, and radiological specialists, as emphasized by 1
If conservative measures fail, surgical options include duodenojejunostomy (most common), Strong's procedure (mobilization of the duodenum), or gastrojejunostomy. Surgery aims to bypass the obstruction or correct the anatomical compression. SMA syndrome requires treatment because chronic duodenal compression can lead to significant weight loss, electrolyte abnormalities, and malnutrition, creating a cycle that worsens the condition as decreased mesenteric fat further reduces the aortomesenteric angle, as noted by 4.
In terms of the most recent and highest quality evidence, the study by 1 published in 2017 in the Annals of the Royal College of Surgeons of England, provides strong support for the use of laparoscopic duodenojejunostomy as a safe and effective surgical option for the management of SMA syndrome.