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Khirurgii

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Year 2023 Vol. 31 No 4

SCIENTIFIC PUBLICATIONS

M.D. LEVIN 1, 2, V.I. AVERIN 1, 3, YU.G. DEGTYAREV 1, 4

ETIOLOGY AND PATHOGENESIS OF THE SUPERIOR MESENTERIC ARTERY SYNDROME. HYPOTHESIS

State Institution "Republican Scientific and Practical Center of Pediatric Surgery" ¹,
Minsk, Republic of Belarus,
Dorot-Netanya Geriatric Medical Center, Israel ²,
Belarusian State Medical University ³, Minsk,
Belarusian Medical Academy of Postgraduate Education 4, Minsk,
Republic of Belarus

Objective. It is currently believed that the cause of superior mesenteric artery syndrome (SMAS) is compression of the duodenum in the angle between the aorta and superior mesenteric artery (SMA). It is recognized that a decrease in aortomesenteric angle (AMA) < 25° and intervascular distance < 8 mm, caused by fat loss, is characteristic of SMAS. Based on these statements, surgeons operate on patients with symptoms of dyspepsia only on a reduction of AMA. This study is devoted to the analysis of the literature, including four own studies on this issue.
Methods. 79 PubMed and PMC articles describing 211 cases of SMAS from 1990 to 2015 have been analyzed
Results. Measurement of the length of the constriction in the third part of the duodenum on the radiograms from the available sources showed that its true length ranged from 2.5 to 4.2 (3.30±0.15) cm and began a few centimeters cranial to the AMA. Therefore, it could not be caused by compression in the AMA. In terms of length (3.20±0.15 cm) and location, this constriction corresponded to Ochsner’s sphincter, which normally short-term contracts to prevent the penetration of an acid bolus into the jejunum. Conscientious studies have shown that AMA is proportional to BMI, i.e., a decrease in AMA is observed in all thin people. An analysis of 211 cases of SMAS made it possible to differentiate two types of diseases. In 101 patients, the disease occurred acutely 1-53 (8.2±1.9) days after stressful situations, accompanied by a catabolic reaction and hypersecretion of hydrochloric acid. In 110 patients, SMAS developed 3-72 (17.2±3.2) months after the diagnosis of a acid-depended diseases.
Conclusion. The analysis led to the conclusion that hypersecretion of hydrochloric acid causes an increase in tone and hypertrophy of the Ochsner’s sphincter, and the clinic of the disease depends on the degree of its dyskinesia, where there is no place for surgical treatment at the so-called SMAS.

Keywords: superior mesenteric artery syndrome, aortomesenteric angle, duodenum, sphincters, conservative treatment
p. 277-287 of the original issue
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Address for correspondence:
4220200, Dorot,
State Geriatic Center,Netanya,
Amnon ve-Tamar 1, Israil
Tel. +972 538281393,
e-mail: nivel70@hotmail.com,
Levin Mikhail D.
Information about the authors:
Levin Mikhail D. MD, Radiologist, State Gerriatric Center (Djrot), Netanya, Israil.
https://orcid.org/0000-0001-7830-1944
Averin Vasily I. MD, Professor, Head of the Department of Pediatric Surgery, Belorussian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-3343-8810
Degtyarev Yury G. Professor of the Department of Pediatric Surgery, Belorussian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-2696-4989
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