Superior Mesenteric Artery Syndrome

I would like to begin first by stating that the purpose of this article is not to illicit sympathy or exploit anything I have gone through for any other reason but education and knowledge. Superior Mesenteric Artery Syndrome (SMA Syndrome) is a rare condition that most often goes un-diagnosed for years because of its symptoms, which are difficult to diagnose.

I am 22 years old, soon to be 23 this May of '06. Throughout those first 21 years of my life I have had to live with the symptoms of SMA Syndrome, knowing nothing at all about the syndrome. My symptoms were chronic stomach pain, and lower abdomen pain, as well as a weak appetite and lack of weight gain. My symptoms fluctuated throughout my life and in my later adolescence toward my young adult stages of life I also began to get chronic headaches, nausea and exhibited frequent vomiting. My main concern was always weight gain, I adapted to the pain and the discomfort, I had no choice it had become a part of my life. All I really wanted was to put on some weight.

I didn't have health insurance because of the costs involved. So I was shuffled around local doctors whom could not really diagnose me without the proper (expensive) testing. I was told so many different things it became, at least in my mind, hopeless. I was told that I just wasn't meant to be heavy, I was meant to be slim. Thus I went on wondering what was wrong with me, or if I was just over reacting. It wouldn't be until I turned 21, and got health insurance that I would begin to understand what I had.

I went through extensive testing, including placing a small camera down my throat into my stomach for exploratory examination. It was then that the doctors concluded that I indeed suffered from SMA Syndrome, when the pictures showed a lower obstruction of the duodenum. The duodenum, into which the stomach opens, is about 25 cm long, C-shaped and begins at the pyloric sphincter. It is almost entirely retroperitoneal and is the most fixed part of the small intestine (http://mywebpages.comcast.net/wnor/duodenum.htm). A blockage of the duodenum creates a slow, or blocked off passage from the stomach to the intestine, causing difficulty in digestion. The duodenum is obstructed by the Mesenteric Artery, which grows at an incorrect angle, thus creates a blockage or compression of the duodenum.

The upper GI (Gastrointestinal) tract (where the duodenum is located), is always the precise located where SMA Syndrome always occurs. SMA Syndrome results in malnutrition, dehydration, electrolyte abnormalities, and even death (http://www.emedicine.com/ped/topic2175.htm), if not treated properly. It is most often found through exploratory examination, because there is no real way to scan for the syndrome; although, there are tests which include radiographic studies, such as an upper GI series, hypotonic duodenography, and CT scanning. I personally went through a series of these tests, and was not confirmed about having SMA Syndrome until I had the scope in my stomach detect the actual blockage, and even then doctors said that it wasn’t 100% conclusive, that I would have to undergo exploratory surgery.

The only way to repair, or fix/reverse SMA Syndrome is through surgery. The doctor must open up the patient and first confirm the artery blockage, scan the GI tract for any other amorality, then repair the blockage through a bypass of the obstruction. There are also other ways of repairing the flow into the intestines, but a bypass of the artery is the standard and safest method. The duodenum is cut before the artery and then after it, then those two incisions are joined and connected, thus restoring flow. The surgery itself takes a few hours, perhaps 4 or so, and the patient remains in the hospital for anywhere between 4-7 days post-surgery.

I underwent surgery July of last year ’05. I was in the hospital for 7 days, since the entire GI tract has to be neutralized (put to sleep, or shut down) for surgery, the recovery process included waiting for the body to naturally “wake-up.” During this time a tube runs into the nose, down the throat and into the stomach to pump out contents that would normally pass through the intestines. This is by far the most uncomfortable part of the recovery process. The scar (mine ran from below the bellybutton up toward the sternum) is also quite uncomfortable when healing and takes quite some time to close up completely. Once you are released from the hospital (only after the GI tract is fully functional and responsive, as well as when the patient can eat solid food without complication), you have to remain in bed, with limited mobility for months, until the scar has closed up and the abdominal muscle has healed enough (since the abdominal muscle was cut during surgery). It takes many months to a year for the abdominal muscle to heal completely, and during this duration of time the patient can undertake no heavy lifting or strenuous activity.

I am now feeling much better and can say that I no longer suffer from all of the symptoms, although some still linger. It will take time to adjust and establish a proper diet and digestion. I would like to add that I had my surgery at Jackson Memorial Hospital in Miami, Florida, and my doctor, Dr. Andreas Tzakis, was by far the best doctor for the surgery. I would like to thank Dr. Tzakis and his staff for the fantastic job they did. Dr. Tzakis is primarily a transplant doctor, but took my case because of his extensive knowledge of the GI tract. Dr. Tzakis, as well as his staff do not get the recognition I believe they truly deserve. Dr. Tzakis, I thank you.

It is my intention, to familiarize my readers of this syndrome because it is not well known. Others whom suffer from identical or similar symptoms may not have a clue that they may indeed suffer from SMA Syndrome. It can lead to death if gone untreated, as well as cause severe pain and discomfort. It is extremely important that individuals whom may suspect they have SMA Syndrome contact a doctor immediately for treatment. It is my hope, and desire that others inflicted with SMA Syndrome get the treatment they require swiftly and effectively. I hope that sharing my experience, even though not in-depth, can reach to others and help get them cured. It is not easy to write about things you don’t wish many people to know about but it is my hope that this article finds someone who may be able to change their life though this treatment and end the symptoms of SMA Syndrome.

Please feel free to e-mail me if you have further questions (lividlizard1@aol.com). Please include a reference to SMA Syndrome in the subject line. Visit the following websites for further research and information. There are many more than these, so if you feel you may have SMA Syndrome, or know someone who does, look around for more extensive literature and studies on SMA Syndrome.

http://mywebpages.comcast.net/wnor/duodenum.htm
http://www.emedicine.com/ped/topic2175.htm
http://www.um-jmh.org/
http://www.everything2.com/index.pl?node_id=1371960