Superior mesenteric artery syndrome

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Classification according to ICD-10
K31.5 Duodenal closure
K31.8 Other specified diseases of the stomach and duodenum
ICD-10 online (WHO version 2019)

The superior mesenteric artery syndrome is a very rare gastrointestinal vascular disease with duodenal stenosis due to compression of the distal duodenal section between the superior mesenteric artery and the aorta .

Synonyms are: Wilkie syndrome; Superior mesenteric artery syndrome; Duodenal compression; acute gastroduodenal obstruction; mesenteric duodenal compression syndrome; Mesenteric root syndrome; Chronic duodenalilus; English Superior mesenteric artery syndrome; SMA syndromes; Cast syndrome; Intermittent arterio-mesenteric occlusion

Not to be confused is the nutcracker syndrome , which affects the left renal vein .


The incidence is estimated to be 0.013-0.3% in the normal population based on MDP (gastrointestinal passage) examinations. After scoliosis operations it is said to occur in 0.5 - 2.4%. Women are affected much more often. The main age of onset is between 10 and 39 years.

root cause

The main causes are:

  • Chronic weight loss
  • trauma
  • Nutritional disorders
  • Postoperatively
  • Anatomical anomalies
  • Local pathologies
Normal angle between aorta and superior mesenteric artery. Part of the duodenum runs between these two vessels.
If the angle is reduced, the duodenum is compressed and compression syndrome occurs.


Normally the angle between the aorta and the superior mesenteric artery is between 38 ° -56 °, the syndrome is triggered by reducing this angle to 6 ° -25 °.

Clinical manifestations

Typical clinical findings are:


Due to the unspecific symptoms and the rarity of this syndrome, diagnosis is difficult and is often made late.


Conservative measures with weight gain, possibly surgical interventions such as duodeno- jejunostomy, are available for treatment .


The first description comes from the year 1842 by the pathologist Carl von Rokitansky .

The clinical picture was defined as a syndrome by DPD Wilkie in 1927 .


  • L. Rodríguez Caraballo, ME Carazo Palacios, V. Ibáñez Pradas, P. Rodríguez Iglesias: [Wilkie syndrome: A differential diagnosis of abdominal pain]. In: Anales de pediatría (Barcelona, ​​Spain: 2003). Vol. 82, No. 6, June 2015, pp. 445-446, doi: 10.1016 / j.anpedi.2014.12.016 , PMID 25649674 .
  • W. Sandmann, S. Pourhassan, et al. a .: Wilkie syndrome. In: The gastroenterologist. 7, 2012, p. 507, doi: 10.1007 / s11377-011-0624-z .
  • T. Gerasimidis, F. George: Superior mesenteric artery syndrome. Wilkie syndrome. In: Digestive Surgery . Vol. 26, No. 3, 2009, pp. 213-214, doi: 10.1159 / 000219330 , PMID 19468230 .
  • I. Laffont, D. Bensmail, C. Rech, G. Prigent, G. Loubert, O. Dizien: Late superior mesenteric artery syndrome in paraplegia: case report and review. In: Spinal cord. Vol. 40, No. 2, February 2002, pp. 88-91, doi: 10.1038 / , PMID 11926421 (review).

Individual evidence

  1. Bernfried Leiber (founder): The clinical syndromes. Syndromes, sequences and symptom complexes . Ed .: G. Burg, J. Kunze, D. Pongratz, PG Scheurlen, A. Schinzel, J. Spranger. 7., completely reworked. Edition. tape 2 : symptoms . Urban & Schwarzenberg, Munich et al. 1990, ISBN 3-541-01727-9 .
  2. a b c d T. Welsch, MW Büchler, P. Kienle: Recalling superior mesenteric artery syndrome. In: Digestive Surgery . Vol. 24, No. 3, 2007, pp. 149-156, doi: 10.1159 / 000102097 , PMID 17476104 (review).
  3. JL Falcone, KO Garrett: Superior Mesenteric Artery Syndrome After Blunt Abdominal Trauma: A Case Report. In: Vascular and Endovascular Surgery. Vol. 44, 2010, p. 410, doi: 10.1177 / 1538574410369390 .
  4. a b Emedicine
  5. a b U. Baltazar, J. Dunn, C. Flore Guerra, L. Schmidt, W. Browder: Superior mesenteric artery syndrome: an uncommon cause of intestinal obstruction. In: Southern medical journal. Vol. 93, No. 6, June 2000, pp. 606-608, PMID 10881780 (review).
  6. C. Rokitansky: Handbook of Pathological Anatomy. , 1st edition, Vienna, Braunmüller & Seidel, 1842, vol. 3, p. 187.
  7. ^ Wilkie DPD: Chronic duodenal ileus. In: The American Journal of the Medical Sciences Vol. 173, 1927, pp. 643-64