Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 29

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 32

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JRequest::clean() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 33

Strict Standards: Non-static method JRequest::_cleanArray() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/environment/request.php on line 463

Strict Standards: Non-static method JRequest::_cleanArray() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/environment/request.php on line 464

Strict Standards: Non-static method JRequest::_cleanArray() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/environment/request.php on line 465

Strict Standards: Non-static method JRequest::_cleanArray() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/environment/request.php on line 466

Strict Standards: Non-static method JRequest::_cleanArray() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/environment/request.php on line 467

Strict Standards: Non-static method JRequest::_cleanArray() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/environment/request.php on line 468

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 35

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 38

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 39

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 46

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 47

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 50

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 53

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 54

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 57

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 58

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JFactory::getApplication() should not be called statically in /home/samehla/public_html/prof/index.php on line 31

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Redefining already defined constructor for class JObject in /home/samehla/public_html/prof/libraries/joomla/base/object.php on line 57

Strict Standards: Non-static method JApplication::getInstance() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/factory.php on line 46

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JApplicationHelper::getClientInfo() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/application/application.php on line 132

Strict Standards: Declaration of JSite::getRouter() should be compatible with & JApplication::getRouter($name = NULL, $options = Array) in /home/samehla/public_html/prof/includes/application.php on line 377

Strict Standards: Declaration of JSite::getPathWay() should be compatible with & JApplication::getPathway($name = NULL, $options = Array) in /home/samehla/public_html/prof/includes/application.php on line 377

Strict Standards: Declaration of JSite::getMenu() should be compatible with & JApplication::getMenu($name = NULL, $options = Array) in /home/samehla/public_html/prof/includes/application.php on line 377

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/registry/registry.php on line 19

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Declaration of JSession::set() should be compatible with JObject::set($property, $value = NULL) in /home/samehla/public_html/prof/libraries/joomla/session/session.php on line 737

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/session/session.php on line 19

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Warning: session_start(): Cannot send session cookie - headers already sent by (output started at /home/samehla/public_html/prof/libraries/joomla/import.php:29) in /home/samehla/public_html/prof/libraries/joomla/session/session.php on line 423

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Warning: session_start(): Cannot send session cache limiter - headers already sent (output started at /home/samehla/public_html/prof/libraries/joomla/import.php:29) in /home/samehla/public_html/prof/libraries/joomla/session/session.php on line 423

Warning: Cannot modify header information - headers already sent by (output started at /home/samehla/public_html/prof/libraries/joomla/import.php:29) in /home/samehla/public_html/prof/libraries/joomla/session/session.php on line 426

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/html/parameter.php on line 21

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Declaration of JRegistryFormatINI::objectToString() should be compatible with JRegistryFormat::objectToString(&$object) in /home/samehla/public_html/prof/libraries/joomla/registry/format/ini.php on line 281

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JPluginHelper::importPlugin() should not be called statically in /home/samehla/public_html/prof/index.php on line 41

Strict Standards: Non-static method JPluginHelper::_load() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/plugin/helper.php on line 92

Strict Standards: Non-static method JPluginHelper::_import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/plugin/helper.php on line 97

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Redefining already defined constructor for class JPlugin in /home/samehla/public_html/prof/libraries/joomla/plugin/plugin.php on line 75

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Declaration of JEvent::update() should be compatible with JObserver::update() in /home/samehla/public_html/prof/libraries/joomla/event/event.php on line 29

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JDispatcher::getInstance() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/plugin/helper.php on line 140

Strict Standards: Non-static method JPluginHelper::getPlugin() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/plugin/helper.php on line 147

Strict Standards: Non-static method JPluginHelper::_load() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/plugin/helper.php on line 41

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

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Superior mesenteric artery syndrome

Superior mesenteric artery syndrome

 

Superior mesenteric artery syndrome

Definition:

Superior mesenteric artery syndrome is an unusual cause of proximal intestinal obstruction. The 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.

the normal angle between the superior mesenteric artery and the aorta is between 38 and 65º due, in part, to the mesenteric fat pad. This angle correlates with body mass index.

In superior mesenteric artery syndrome, the angle

 can be narrowed to as low as 6º which minimizes the space between the superior mesenteric artery and aorta leading to duodenal compression.

Susceptible patients:

Several factors can decrease the acuity of the angle between the aorta and superior mesenteric artery.

1. The most common is significant weight loss leading to loss of the mesenteric fat pad as a consequence of medical disorders (as malignancy & malabsorption), psychological disorders ( as anorexia nervosa & depression) or surgery.

2. Anatomic abnormalities, congenital, or acquired (as corrective spinal surgery for scoliosis & esophagectomy) can also contribute.

Clinical presentation:

Patients may present acutely or gradually by symptoms of proximal small intestinal obstruction.

Patients with mild obstruction may have only postprandial epigastric pain & early satiety.

Those with more advanced obstruction may have severe nausea, bilious vomiting & weight loss. Patients may also have symptoms of reflux.

Symptoms may be relieved when patient is lying prone, in the left lateral decubitus, or in a knee-chest position. These positions remove tension from the mesentery and superior mesenteric artery, opening the space between the superior mesenteric artery & aorta.

Physical examination is normal, but abdominal distension & succussion splash may be present.

Electrolyte disturbances may be present with severe vomiting.

Complications may occur as:

Diagnostic investigations:

1. Plain abdominal erect:

May reveal findings suggestive of proximal small intestinal obstruction, such as gastric distension, dilation of the proximal duodenum, and, occasionally, an abrupt vertical cutoff of air in the third portion of the duodenum.

2. Gastrografin (or barium) follow-through:

Usually demonstrate marked delay in passage of the contrast from the duodenum into the more distal small bowel. Passage of contrast typically halts abruptly at the third portion of the duodenum. The proximal duodenum and stomach are dilated and show prolonged retention of the contrast.

3. CT with oral & intravenous contrast:

4.  Ultrasonography:

Trans-abdominal and endoscopic ultrasonography can identify and measure the aorto-mesenteric angle.

5. Arteriography:

Conventional, CT, and MR arteriography demonstrate the superior mesenteric artery superimposed upon the barium-filled duodenum. And demonstrate the narrowing of the aorto-mesenteric angle

Treatment:

I. Conservative treatment:

1. Inserting a Nasogastric tube:

Nasogastric tube decompresses the dilated stomach and proximal duodenum and improves patient discomfort.  

2. Correction of electrolyte disturbances:

Vomiting can lead to hypovolemia, hypokalemia, and metabolic alkalosis. Fluid and electrolyte correction should be done.

3. Nutritional support: (the major component of therapy).

Psychiatric evaluation, to manage eating disorders.

Enteral or parenteral  nutrition is usually required, at least in the initial stages until patients are able to increase oral intake. Once significant weight gain is noted, the diet is advanced slowly.

II. Surgical treatment:

Surgery is the option if conservative nutritional therapy fails to resolve the condition.

Outcomes of surgery:

In a study included 16 patients who were followed seven years after surgery, weight loss had been corrected & vomiting, was significantly decreased. In another study of eight patients, symptoms were improved; however, significant weight gain was not seen.

Last Updated on Thursday, 18 May 2017 11:13