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SMA syndrome / Wilkie’s syndrome / Cast syndrome / Mesenteric root syndrome / Chronic duodenal ileus and intermittent arterio-mesenteric occlusion.

* It is distinct from Nutcracker syndrome, which is the entrapment of the left renal vein between the Abdominal aorta  and the SMA.

Superior mesenteric artery (SMA) syndrome is a very rare, life-threatening gastrovascular disorder characterized by a compression of the third portion of the duodenum by the abdominal aorta (AA) and the overlying superior mesenteric artery. The syndrome is typically caused by an angle of 6°-25° between the AA and the SMA, in comparison to the normal range of 38°-56°, due to a lack of retroperitoneal and visceral fat. In addition, the aortomesenteric distance is 2-8 millimeters, as opposed to the typical 10-20.


Retroperitoneal fat and lymphatic tissue normally serve as a cushion for the duodenum, protecting it from compression by the SMA. SMA syndrome is thus triggered by any condition involving an insubstantial cushion and narrow mesenteric angle.

By Dr. Tushar Mehta


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