Main Symptoms of Superior Mesenteric Artery and Nutcracker Syndrome
Superior Mesenteric Artery Syndrome
The main symptoms of Superior Mesenteric Artery (SMA) syndrome include postprandial abdominal pain, nausea, vomiting, early satiety, fear of eating (sitophobia), and progressive weight loss. 1
Characteristic Symptoms
- Postprandial epigastric pain that worsens after meals 1
- Nausea and vomiting, often with bilious content 2
- Early satiety and food aversion despite normal appetite 1, 2
- Significant weight loss due to reduced food intake 1, 2
- Fear of eating (sitophobia) 1, 3
Clinical Presentation
- Symptoms typically worsen in the supine position and may improve when the patient is in a left lateral decubitus, prone, or knee-chest position 4, 2
- Symptoms often develop or worsen following significant weight loss, which further narrows the aortomesenteric angle 2, 5
- The condition can mimic anorexia nervosa or functional dyspepsia 2
- Symptoms can be chronic, intermittent, or acute 4
Pathophysiology
- SMA syndrome occurs when the third part of the duodenum is compressed between the superior mesenteric artery and the aorta 4, 2
- The normal aortomesenteric angle of 38-65° is reduced to 6-25° in SMA syndrome 2
- Loss of retroperitoneal fat cushion (often due to weight loss) is a common precipitating factor 2, 5
Nutcracker Syndrome
Nutcracker syndrome occurs when the left renal vein is compressed between the superior mesenteric artery and the aorta, causing symptoms related to renal venous hypertension. 1, 5
Characteristic Symptoms
- Left flank pain 5
- Hematuria (microscopic or macroscopic) 5
- Proteinuria 5
- Left-sided varicocele in males 5
- Pelvic congestion syndrome in females (dysmenorrhea, dyspareunia, pelvic pain) 5
Combined Syndrome
- Both conditions can coexist due to the shared anatomical relationship with the superior mesenteric artery 5
- When both syndromes occur together, symptoms from both conditions may be present simultaneously 5
- Weight loss can exacerbate both conditions by reducing the aortomesenteric angle 5
Diagnostic Considerations
- SMA syndrome should be suspected in patients with postprandial abdominal pain and significant weight loss 1, 2
- Diagnosis is confirmed with imaging studies such as CT angiography, upper GI series with barium, or MR angiography 1, 3
- Endoscopy may be performed to rule out other causes of obstruction 2
- Nutcracker syndrome is diagnosed with Doppler ultrasound, CT angiography, or MR angiography showing compression of the left renal vein 5
Clinical Pitfalls
- SMA syndrome is often underdiagnosed or misdiagnosed as functional dyspepsia, eating disorders, or psychosomatic disorders 2
- Symptoms can mimic other gastrointestinal disorders, leading to delayed diagnosis 2
- The condition should be considered in the differential diagnosis for patients with unexplained weight loss and postprandial abdominal pain 1
- Recurrent vomiting can lead to complications such as aspiration pneumonia or metabolic alkalosis 2
Understanding these characteristic symptoms is crucial for early diagnosis and appropriate management of these rare but significant vascular compression syndromes.