Duodenal compression caused by superior mesenteric artery:: study of 10 patients

Background: the compression of the third portion of the duodenum by the superior mesenteric artery (aorto-mesenteric clamp) is a rare cause of abdominal pain. Its clinical appearance may range between an asymptomatic and accidental radiological finding and an acute duodenal ileus (superior mesenteric artery syndrome), which requires urgent surgical intervention. Methods: we revised all of the reports of upper gastrointestinal tract contrast-medium study (which included the duodenum) made in our hospital between May 1999 and April 2002. We analysed the case history of those patients with a radiological image compatible with aorto-mesenteric clamp. Results: of the 1280 studies analysed, 10 of them (0,78%) were compatible with an aorto-mesenteric clamp. The 10 patients were females whose mean age was 25,7 years (range 9-77) that consulted for different abdominal discomfort. The symptoms of the 9 youngest patients were not typical of duodenal obstruction and their evolution was favourable. In the eldest patient, the clinical data were compatible with a mesenteric superior artery syndrome, although a subsequent study showed the presence of a colon adenocarcinoma. Conclusions: the aorto-mesenteric clamp is a rare radiological finding (< 1 %) which does not always justify the supported clinical data. In our series, 9 cases were considered non-obstructive aorto-mesenteric clamps, although some of them showed patho-genical factors (scoliosis and thinness). The superior mesenteric artery syndrome should be considered as a diagnosis of exclusion after performing an adequate clinical study when the situation of the patient requires it.