Superior mesenteric artery syndrome (SMAS), a solution of the puzzle. Systematic review of reported cases

Abstract Introduction: Superior mesenteric artery syndrome (SMAS) is an uncommon medical condition. Symptoms associated with SMAS may mimic those of various other medical conditions, leading to potential delays in diagnosis. The decision between conservative management or surgical intervention often lacking clarity. Methods: A systematic review was conducted, 474 cases out of 262 articles were analyzed. Result: SMAS were predominantly observed in females during their second and third decades of life. A significant peak in incidence was noted among teenage patients. The primary pathology leading to SMAS was found to be surgical procedures, followed by psychiatric conditions. Among the common symptoms reported, vomiting was the most frequent followed by abdominal pain and nausea. Weight loss was reported in approximately 40% of patients. Conservative treatment was successful in 37.8% of all patient. Surgical intervention was ultimately chosen as the treatment of choice in 62.26% of cases. Notably, surgical treatment was more common in Europe compared to Asia and America. The duration of symptoms played a significant role in determining treatment strategy. Approximately 5% of cases reported persistent symptoms or complications, with 1.5% of mortality. Conclusion: Superior mesenteric artery syndrome should be in the list of differential diagnosis of any epigastric pain with vomiting and weight loss, especially within teenage females. The duration of symptom could orient the treatment strategy in which the conservative treatment could attempt in patient with shorter duration of symptoms. Duodenojejunal anastomosis is the first line of surgical management.