Superior Mesenteric Artery Syndrome: A Case Report of Two Surgical Options, Duodenal Derotation and Duodenojejunostomy

Figure 5

Superior mesenteric artery (SMA) syndrome. The superior mesenteric artery arises from the anterior aspect of the aorta at the level of the L1 vertebral body. It is enveloped in fatty and lymphatic tissue and extends in a caudal direction at an acute angle into the mesentery. In the majority of patients, the normal angle between the superior mesenteric artery and the aorta is between 38 and 65 degrees. Superior mesenteric artery syndrome is characterized by compression of the third portion of the duodenum due to narrowing of the space between the superior mesenteric artery and aorta and is primarily attributed to loss of the intervening mesenteric fat pad. With superior mesenteric artery syndrome, the angle between the superior mesenteric artery and the aorta can be narrowed to as little as 6 degrees (Case Report One) (see [3]).