Alsaleh Nourah, Yaseen Waed, Alshamat Renad Abo, Aljurushi Raghad, Alshareef Basem
Department of Surgery-Surgical Oncology, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Saudi Arabia.
Ann Med Surg (Lond). 2025 Mar 28;87(5):2763-2773. doi: 10.1097/MS9.0000000000003209. eCollection 2025 May.
Superior mesenteric artery syndrome (SMAS) is a rare characterized by obstruction of the third portion of the duodenum due to compression of this region between the superior mesenteric artery (SMA) and aorta. Diagnosis of SMAS post-surgical procedures is challenging due to nonspecific symptoms.
In accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines, five electronic databases were systematically searched of all case reports published on SMAS diagnosed after colorectal procedures up to October 2023. The primary search of the databases revealed a total of 70 published articles. Thirty-eight studies were included.
to discuss the prevalence of SMAS post-colorectal surgery, possible causes, preventive measures and best management options.
Total proctocolectomy with ileal J-pouch anal anastomosis was the most commonly reported surgical procedure (41.6%) preceding the diagnosis. Onset of symptoms since the primary operation had a wide range 1 day to >10 years. With a significant relation ( = 0.017) between duration of conservative treatment (>2 weeks) and its success.
Our study was limited by a small sample size, the retrospective nature of data collection, variability in patient populations, surgical techniques, and postoperative care protocols across the included studies, and short follow-up periods.
Majority of patient with SMAS following a colorectal surgery had successful conservative management (62.9%) within the time frame of 2-4 weeks (78.5%), while most reported patients with more extended conservative period eventually resorted to surgical management.
While conservative management is usually effective, surgical intervention should always be considered if there is no improvement within 4 weeks. Future research should focus on larger prospective studies to validate these findings and explore additional predictors of treatment success.
肠系膜上动脉综合征（SMAS）是一种罕见疾病，其特征是十二指肠第三部因肠系膜上动脉（SMA）与主动脉之间对该区域的压迫而受阻。由于症状不具特异性，术后诊断SMAS具有挑战性。
按照系统评价和Meta分析的首选报告项目指南，系统检索了五个电子数据库，以查找截至2023年10月在结直肠手术后诊断为SMAS的所有病例报告。对数据库的初步检索共发现70篇已发表文章。纳入了38项研究。
探讨结直肠手术后SMAS的患病率、可能原因、预防措施和最佳管理方案。
全直肠系膜切除术加回肠J袋肛管吻合术是诊断前最常报告的手术（41.6%）。自初次手术以来症状出现的时间范围很广，从1天到超过10年。保守治疗持续时间（>2周）与其成功率之间存在显著相关性（P = 0.017）。
我们的研究受到样本量小、数据收集的回顾性性质、纳入研究中患者人群、手术技术和术后护理方案的变异性以及随访期短的限制。
大多数结直肠手术后发生SMAS的患者在2至4周（78.5%）的时间范围内成功进行了保守治疗（62.9%），而大多数报告的保守治疗期更长的患者最终诉诸手术治疗。
虽然保守治疗通常有效，但如果4周内无改善，应始终考虑手术干预。未来的研究应侧重于更大规模的前瞻性研究，以验证这些发现并探索治疗成功的其他预测因素。
