The mesentery is a double fold that suspends the small intestine and large intestine from the posterior abdominal wall. The third section can be compressed by the SMA against the AA causing a partial obstruction which manifests as nausea, vomiting and epigastric pain. The duodenum is the first part of the small intestine and directly connects to the stomach.
Each section has a role in digestion and absorption of nutrients that were previously digested in the stomach. The small intestine is divided into three sections – duodenum, jejunum and ileum. The small intestine is a long, winding tube that connects the stomach to the large intestine ending in the anus. SMA syndrome occurs when the duodenum is compressed by the SMA against the AA to cause blockage and prevent progression of food or fluids into the rest of the small intestine. Most people affected have no symptoms but those affected will have left flank and pelvic pain and may have blood in the urine (hematuria). Some affected individuals may also have nutcracker syndrome in which the left renal vein (kidney vein) is compressed by the AA and SMA.
Food aversion or food fear follows which aggravates the weight loss and worsens SMA syndrome. The abdominal pain can be severe after intake of food or drink because the pulsation of the SMA becomes stronger and bounding against the duodenum. Relief can be obtained by lying on the right decubitus or left decubitus (right or left side down) or face down (prone) with both arms and legs up (knee to chest position) after eating or drinking to allow the stomach to empty better. Vomiting of undigested food can occur and can become bilious i.e., green or yellow when the blockage becomes severe. Constipation can occur when there is delay in stomach emptying.
#COMPRESS SYNONYM FULL#
The stomach remains full of fluid or food previously ingested hours before.
Symptoms can include nausea, vomiting, abdominal pain, indigestion (dyspepsia) and early satiety, in which the person feels full despite having very little food or drink because the stomach is not emptying. Sometimes symptoms can come and go (intermittent). Generally, the initial symptoms are nonspecific, which means that symptoms are common ones that can be associated with many different conditions. Without treatment, in some people, symptoms can be severely disabling. Sometimes the symptoms are mild and build slowly over time. The signs and symptoms can vary greatly from one person to another. SMA syndrome is considered extremely uncommon and most consider this as a diagnosis of exclusion i.e., many other more common diagnoses must be ruled out. Prompt diagnosis and early treatment are essential to avoid significant complications or death. When weight loss is persistent, the mesenteric fat pad decreases and causes a decrease in the angle between the SMA and AA hence aggravating the compression and obstruction. Nausea and vomiting are manifestations of the compression of the duodenum. Pain from the compression can be debilitating, causing “food fear” and aggravating the condition. Compression of the SMA against the AA can prevent duodenal contents from draining into the jejunum (upper small intestine) hence the inability to get proper nutrition leading to weight loss and malnutrition. The SMA provides blood supply to the small intestines and the first part of the colon. This condition occurs when the third part of the duodenum is compressed between two arteries – the main artery of the body called the abdominal aorta (AA) and one of its branches called the SMA. Superior mesenteric artery (SMA) syndrome is a rare condition that involves compression of the third portion of the duodenum which is the upper part of the small intestines just past the stomach.
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