Superior mesenteric artery syndrome: An often overlooked cause of abdominal pain!

Saudi Med J. 2021 Oct;42(10):1145-1148. doi: 10.15537/smj.2021.42.10.20210509.


Objectives: To determine the prevalence of superior mesenteric artery (SMA) syndrome in patients presenting with abdominal pains, and to evaluate computed tomographic (CT) findings needed for its diagnosis.

Methods: This retrospective record-based study was carried out at the radiology department, from January 2016 to January 2021. All young patients (aged under 25) who underwent CT scans for abdominal pains were reviewed. Post-surgery, tumor, and trauma cases were excluded. Imaging findings for SMA syndrome were recorded as 'suggestive' (reduced aortomesenteric angle and distance with proximal duodenal dilatation), 'possible' (reduced angle and distance without proximal duodenal dilatation) and 'probable' (reduction of either angle or distance). Two radiologists interpreted the findings and consensus reporting was made. Diagnoses were confirmed on clinical grounds (symptomatic improvement by specific treatment and exclusion of other diagnoses), or barium studies. Imaging findings were compared to final diagnoses. McNemar's Chi-square test was used to determine association.

Results: Out of 141 patients (mean age=10.8, standard deviation=4), 7 (4.9%) patients mostly females were having SMA syndromes based on 'suggestive' imaging criteria (p=0.0005), and one patient underwent surgery.

Conclusion: Superior mesenteric artery syndrome is not an uncommon condition and should be considered in differential diagnosis of acute abdomen in young patients after excluding other diagnoses.

Keywords: SMA syndrome; aortomesenteric angle; computed tomography.

MeSH terms

  • Abdominal Pain / diagnostic imaging
  • Abdominal Pain / etiology
  • Aged
  • Child
  • Duodenum
  • Female
  • Humans
  • Male
  • Retrospective Studies
  • Superior Mesenteric Artery Syndrome* / complications
  • Superior Mesenteric Artery Syndrome* / diagnostic imaging
  • Tomography, X-Ray Computed