Conservative treatment of superior mesenteric artery syndrome

To assess predictive factors for failure in the conservative treatment of patients with superior mesenteric artery syndrome (SMAS).

A retrospective case-control study was carried out. Cases included pediatric patients diagnosed with SMAS and treated in our institution from 2013 to 2024. Controls included surgically treated SMAS patients under 20 years of age from a PubMed bibliographic review. Of a total of 205 papers, 24 met inclusion criteria. Demographic, clinical, diagnostic, therapeutic, and progression variables were collected. Statistical analysis was performed using chi-square/Fisher and Mann-Whitney U tests.

N= 42 (16 cases and 26 controls). No statistically significant differences were found in terms of BMI (17.25 vs. 14.43; U= 148.5; p= 0.398), progression time (130 vs. 90 days; U= 176.0; p= 0.820), angle (19° vs. 14.1°; U= 159.0; p= 0.206), or aortomesenteric distance (3.5 cm vs. 4.25 cm; U= 62.5; p= 0.068). Cases received conservative treatment, except for one who refused this treatment modality. There were no significant differences regarding final BMI (18.6 vs. 17.9; U= 96.0; p= 0.560), treatment success, or hospital stay (7.0 vs. 6.0 days; U= 168.0; p= 0.308) between both groups.

Conservative treatment is highly successful regardless of progression time, BMI, angle, and aortomesenteric distance. Therefore, surgery is not recommended as the first option in the management of SMAS.