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Oral Presentation - 8
Nutritional and Positional Therapy for SMA Syndrome in Adolescents: A Case Series from a Single Center
Kübra Öztürk Yüzdemir 1, İdil Rana User 1, Burak Ardıçlı 1, Hatice Nursun Özcan 2, Saniye Ekinci 1
1 Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkiye
2 Hacettepe University, Faculty of Medicine, Department Pediatric Radiology
Introduction: Superior Mesenteric Artery (SMA) syndrome is a rare form of partial duodenal obstruction caused by compression of duodenum between the SMA and aorta. Any condition associated with severe acute weight loss can lead to this entity. Here we present our case series with a special emphasis on conservative management.
Case presentation: There were five (four females, one male) patients aged between 15-17 years old presenting with vomiting and weight loss. The median BMI at admission was 17.5, with one patient notably having a BMI of 10.7, indicating severe malnutrition. We used doppler ultrasonography for aortomesenteric angle measurement in two patients and computed tomography in one. Upper gastrointestinal series demonstrated partial duodenal obstruction in four patients. To bypass duodenal obstruction, nasojejunal (NJ) tube was placed in three patients with a median NJ feeding duration of 37 days. Decompression gastrostomy with feeding jejunostomy were created with minimaly invasive method in two patients- one with the history of scoliosis surgery, situs inversus totalis, and the male patient with MNGIE syndrome. Enteral nutrition was established via NJ or jejunostomy tubes with median parenteral nutrition support duration of 18 days. Patients were initially started on low-volume continuous enteral feedings and gradually transitioned to bolus feedings as tolerated. Patients were placed in ‘knee chest position’ just after meals to relieve pressure on duodenum during first weeks of treatment. Median hospital stay was 40 days. Weight gain was achieved in all patients. None of the patients had recurrence and all managed without duodenojejunostomy.
Conclusion: Conservative management of SMA syndrome in adolescents can be effective, even in complex cases provided that enteral nutrition is maintained. Tube jejunostomy and NJ tubes are effective routes for symptom resolution without need for invasive surgery. Close follow-up is essential to monitor clinical and anatomical outcomes.