Recurrent abdominal pain is common in pediatric practice. Frequently no organic cause is established after extensive clinical and laboratory studies. It is the purpose of this report to call attention to the superior mesenteric artery syndrome (SMAS) as a cause of abdominal pain and to discuss its pathogenesis, diagnosis, and treatment.
The SMAS is an obstruction of the duodenum in the transverse portion proximal to the ligament of Treitz. It is produced by the dorsal mesentery which includes the superior mesenteric artery with its accompanying veins, nerves, fibrous tissue, fat, and lymph nodes. Obstruction varies from minimal to complete. It is intermittent to constant and may be symptomatic or asymptomatic. The symptoms and signs produced by SMAS are similar to those due to any duodenal obstruction distal to the ampulla of Vater.
Organic obstruction in the distal duodenum by the SMAS was first reported by von Rokitansky1 in 1861.