Aorto-mesenteric space reduction in women with anorexia nervosa: retrospective audit and analysis

Superior mesenteric artery syndrome (SMAS) is a rare condition favored by weight loss, with nonspecific digestive complaints that may hinder weight recovery in anorexia nervosa. This study aimed to examine the radiological features of aorto-mesenteric (A-M) space reduction in anorexia nervosa and their association with digestive complaints.

Female patients with anorexia nervosa and a history of computerized tomography angiography for digestive complaints were included. Clinical data were retrospectively collected and computerized tomography scans were reviewed by an independent, experienced radiologist to identify signs of SMAS and of Nutcracker syndrome. Adipose tissue surfaces were also calculated from the scans. Some patients were reassessed after nutritional recovery.

On the 51 female patients included (mean age 27.7 ± 12.3 years) from a cohort of 202 female anorexia nervosa patients, 48 met radiological criteria for SMAS (A-M angle < 25° or distance ≤ 8 mm). A duodenal dilation was present in 35 patients (68.6%) and a left renal vein dilation in 39.2%. The type of digestive complaints did not differ significantly between patients with and without duodenal dilation, although gastroesophageal reflux approached statistical significance (p = 0.06). Body mass index and visceral adipose tissue did not correlate significantly with A-M measurements. Following nutritional recovery in ten patients, there was a significant increase in A-M measurements and a decrease in both duodenal dilation and digestive symptoms.

Radiological features of A-M space reduction are common in anorexia nervosa. Left renal vein compression and its upstream dilation, as well as left dilated ovarian vein and pelvic varicose veins, are frequently associated with radiological signs of SMAS. Nutritional support alleviates digestive complaints related to SMAS.