The ultrasound variations of aortomesenteric distance during upper endoscopy in patients with superior mesenteric artery syndrome

Aim: Superior mesenteric artery syndrome can be difficult to diagnose, and diagnosis is often made by exclusion. Ultrasound can play a prominent part in detecting of this condition.

Beside the measurement of the aortomesenteric distance and of the angle between these vessels, this study tries to assess the importance of other parameter: the position of superior mesenteric artery reported to aorta in vertical projection.

Materials and methods: Using B mode and Color Doppler techniques the aortomesenteric distance and the position of superior mesenteric artery reported to aorta in vertical projection was evaluated at three distinct levels: proximal of the origin, at the left renal vein crossing and at the duodenal crossing, before and immediately after upper endoscopy, in 500 consecutive patients without obstructive complains. The anatomical findings in five patients with confirmed superior mesenteric artery syndrome were compared with the dates from the general group.

Results: The specific character for the third mentioned level measurement consist in a large variability of the superior mesenteric artery placement from right to left. In all five confirmed cases, superior mesenteric artery rides aorta on left side position, in an angle ranged of 15 to 25. Aortomesenteric distance at the same level is not exceeding 3,8mm. Hidrosonography showed an enlarged DI and DII.

Conclusion: The left side placement of the superior mesenteric artery in conjunction with an up to 3,8mm of the aortomesenteric distance had to be considered the main important ultrasound criteria in Superior Mesenteric Artery Syndrome Diagnosis