Further Outpatient Care

Nasojejunal or nasogastric tube feedings with a standard liquid diet may be indicated in some patients with superior mesenteric artery (SMA) syndrome. These feedings may be continued at home until the obstruction resolves spontaneously.

Complications

Complications include the following:

Electrolyte imbalance (eg, hypokalemia, hypochloremia, metabolic alkalosis)
Dehydration
Malnutrition
Oliguria
Hypotension
Peptic ulcer disease
Aspiration pneumonia

Prognosis

The outcome is excellent if the entity is diagnosed in a timely fashion and if the patient receives appropriate therapy. In the past, deaths due to progressive dehydration, hypokalemia, and oliguria have been reported; most of these occurred in patients in whom the diagnosis was delayed or missed.

Questions

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Media Gallery

Prompt gastric emptying of residual contrast is present within the stomach into the second portion of the duodenum. Additional contrast was hand injected through the transpyloric feeding tube to further distend the second portion of the duodenum. The second portion of the duodenum is dilated with very slow transit across the spine into the jejunum. This occurred despite difference in position of the patient. The high-grade partial obstruction at the distal second portion of the duodenum is due to superior mesenteric artery (SMA) syndrome.

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Author

Frederick Merrill Karrer, MD, FACS Professor of Surgery and Pediatrics, Head, Division of Pediatric Surgery, University of Colorado School of Medicine; The Dr David R and Kiku Akers Chair in Pediatric Surgery, Surgical Director, Pediatric Transplantation, The Children’s Hospital of Colorado

Frederick Merrill Karrer, MD, FACS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Study of Liver Diseases, American College of Surgeons, American Pediatric Surgical Association, American Society of Transplant Surgeons, Denver Academy of Surgery, International Pediatric Transplant Association, Pacific Association of Pediatric Surgery, Transplantation Society, Western Surgical Association, Western Trauma Association

Disclosure: Nothing to disclose.

Coauthor(s)

Stephanie A Jones, DO Resident Physician, Department of Pediatric Surgery, University of Colorado School of Medicine

Stephanie A Jones, DO is a member of the following medical societies: American College of Surgeons, American Medical Association

Disclosure: Received salary from University of Colorado Denver for employment.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin; Attending Gastroenterologist, Director, Cyclic Vomiting Program, Children’s Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching. for: Abbott Nutritional, Abbvie, speakers' bureau.

Additional Contributors

Jorge H Vargas, MD Professor of Pediatrics and Clinical Professor of Pediatric Gastroenterology, University of California, Los Angeles, David Geffen School of Medicine; Consulting Physician, Department of Pediatrics, University of California at Los Angeles Health System

Jorge H Vargas, MD is a member of the following medical societies: American Liver Foundation, Latin American Society of Pediatric Gastroenterology, Hepatology & Nutrition, American Society for Gastrointestinal Endoscopy, American Society for Parenteral and Enteral Nutrition, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Avinash Shetty, MD, and Ivor D Hill, MB, ChB, DCH, FCP, MD, to the original writing and development of this article.

Sections Superior Mesenteric Artery (SMA) Syndrome
Overview
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Superior Mesenteric Artery (SMA) Syndrome Follow-up

Further Outpatient Care

Complications

Prognosis

References

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