From the Research
The initial treatment for Superior Mesenteric Artery (SMA) syndrome is usually conservative, including postural change, gastroduodenal decompression, and nutrient management, with a success rate of 70%-80%. This approach is based on the most recent and highest quality study available, which emphasizes the importance of conservative management as the first line of treatment 1. The goal of conservative management is to reduce duodenal compression and improve nutritional status, which can help to increase the aortomesenteric angle and relieve compression.
Some key components of conservative management include:
- Positioning the patient in a left lateral decubitus or prone position after meals to reduce duodenal compression
- Nutritional rehabilitation with small, frequent meals that are high in calories and nutrients
- Enteral feeding, preferably with a nasojejunal tube placed beyond the obstruction, in more severe cases
- Parenteral nutrition if enteral feeding is not tolerated
- Prokinetic agents, such as metoclopramide, to improve gastric emptying
Surgical intervention, such as laparoscopic duodenojejunostomy, is considered only when conservative management fails, with a success rate of 80%-100% 1. It is essential to note that the decision to proceed with surgical intervention should be made on a case-by-case basis, taking into account the individual patient's condition and response to conservative management.
The pathophysiology of SMA syndrome involves the compression of the third part of the duodenum between the SMA and the abdominal aorta, leading to small bowel obstruction 2. The normal angle between the aorta and SMA is reduced, causing gastric outlet obstruction 3. The incidence of SMA syndrome is rare, ranging from 0.013% to 0.3% 3.
In real-life clinical practice, it is crucial to prioritize conservative management and reserve surgical intervention for cases where conservative management fails or is not tolerated. This approach is supported by the available evidence, which emphasizes the importance of conservative management as the first line of treatment for SMA syndrome 1, 4, 3, 2.