Endoscopic features for early detection of superior mesenteric artery syndrome in children

Abstract Background Superior mesenteric artery syndrome (SMA) syndrome is a rare cause of duodenal obstruction. Diagnostic delay of SMA syndrome is common due to its rarity and lack of index of clinical suspicion. Present study aims to explore the endoscopic features for early decision to evaluate SMA syndrome in children. Methods In case controlled observation study, we identified three endoscopic findings in enrolled cases like as, finding I: a pulsating band like luminal narrowing of the third part of the duodenum without no expansion over one third during air insufflation for at least 15 seconds, finding II: marked dilatation of the duodenal second part during air insufflation at the duodenal third part, and finding III: bile lake in the stomach. SMA syndrome was confirmed with upper GI series in patients with endoscopic finding I or I plus more. We analyzed positive endoscopic findings related with SMA syndrome. Results Twenty-nine patients consisted of 18 (62.1%) cases with SMA syndrome and 11 (37.9%) cases without SMA syndrome. The 3 most common presenting symptoms were postprandial discomfort, abdominal pain, and early satiety. The initial impressions before endoscopy were functional dyspepsia (37.9%), gastritis or gastric ulcer (31.0%), and SMA syndrome (24.1%). Sixteen patients (55.2%) had the constellation of three endoscopic findings (finding I + II + III). Of them, 72.2% confirmed with SMA syndrome, and 27.3% had no SMA syndrome in upper GI series (P = 0.027). Conclusions Endoscopic examination down to the third part of duodenum can provide a clue making a decision to evaluate SMA syndrome, which includes a feature composed of three findings like as a pulsating band like luminal narrowing of duodenal third part, a marked expansion of duodenal second part, and a bile lake in the stomach.