Pediatric Superior Mesenteric Artery Syndrome

  • Etiology: thin body habitus, recent severe weight loss, scoliosis surgery
  • UGI: obstruction at duodenal horizontal limb over the spine by superior mesenteric artery
  • CT: superior mesenteric artery (SMA) angle to aorta normally 45 degrees but in SMA syndrome is 6-25 degrees, SMA to aorta distance normally 10-20 mm but in SMA syndrome is 2-8 mm
  • Treatment: feeding tube tip beyond ligament of Treitz to help patient gain weight to relieve obstruction
  • Clinical: postprandial discomfort, bilious vomiting

Radiology Cases of Superior Mesenteric Artery Syndrome

Upper GI of superior mesenteric artery syndrome
Delayed AP image from an upper GI shows a markedly dilated first and second part of the duodenum to the right of the spine with a marked narrowing and transition in duodenal caliber over the spine and only a small amount of contrast in the third part of the duodenum to the left of the spine. During the exam, marked to and fro peristaltic motion was noted in the first and second parts of the duodenum.
UGI of superior mesenteric artery syndrome
AP image from an upper GI exam shows extremely dilated first and second portions of the duodenum. There was continuous to and fro motion of contrast in the duodenum and over 15 minutes no contrast passed across the spine and through the duodenal C-loop.