Superior mesenteric artery syndrome following colorectal surgery: a systematic review

Superior mesenteric artery syndrome (SMAS) is a rare characterized by obstruction of the third portion of the duodenum due to compression of this region between the superior mesenteric artery (SMA) and aorta. Diagnosis of SMAS post-surgical procedures is challenging due to nonspecific symptoms.

In accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines, five electronic databases were systematically searched of all case reports published on SMAS diagnosed after colorectal procedures up to October 2023. The primary search of the databases revealed a total of 70 published articles. Thirty-eight studies were included.

to discuss the prevalence of SMAS post-colorectal surgery, possible causes, preventive measures and best management options.

Total proctocolectomy with ileal J-pouch anal anastomosis was the most commonly reported surgical procedure (41.6%) preceding the diagnosis. Onset of symptoms since the primary operation had a wide range 1 day to >10 years. With a significant relation (P = 0.017) between duration of conservative treatment (>2 weeks) and its success.

Our study was limited by a small sample size, the retrospective nature of data collection, variability in patient populations, surgical techniques, and postoperative care protocols across the included studies, and short follow-up periods.

Majority of patient with SMAS following a colorectal surgery had successful conservative management (62.9%) within the time frame of 2-4 weeks (78.5%), while most reported patients with more extended conservative period eventually resorted to surgical management.

While conservative management is usually effective, surgical intervention should always be considered if there is no improvement within 4 weeks. Future research should focus on larger prospective studies to validate these findings and explore additional predictors of treatment success.