Superior Mesenteric Artery Syndrome Across Adulthood: A Retrospective Clinicoradiological Case Series

Background and Objectives: Superior mesenteric artery syndrome (SMAS) is an uncommon cause of proximal duodenal obstruction that requires clinicoradiological correlation. Materials and Methods: We retrospectively reviewed 13 patients with SMAS identified at the Clinical County Emergency Hospital Bihor, Romania, during 2019-2024. Clinical records and contrast-enhanced computer tomography (CT) examinations were reviewed descriptively. Results: The cohort included 13 adults aged 19-85 years (mean 45.5 ± 17.8; median 43 years). Abdominal pain was reported in 12/13 patients (92.3%), vomiting or emetic symptoms in 6/13 (46.2%), feeding difficulty or appetite disturbance in 5/13 (38.5%), and documented weight loss in 3/13 (23.1%). CT measurements were available for the aortomesenteric angle in 7/13 patients (range, 10-25°) and for the aortomesenteric distance in 8/13 (range, 3-8 mm); direct third-part duodenal compression and proximal dilatation were interpreted together with compatible symptoms. Imaging showed Nutcracker-type left renal vein compression in 3/13 patients (23.1%) and possible May-Thurner anatomy in 1/13 (7.7%); these findings were not adjudicated as clinical syndromes without corresponding manifestations. Based on the management labels, 9/13 patients (69.2%) underwent surgery at some point and 4/13 (30.8%) received medical therapy only. Standardized follow-up and procedure-level outcome data were not available for all patients. Conclusions: This small, retrospective series is descriptive and cannot estimate prevalence, diagnostic delay, or comparative treatment effectiveness. It illustrates heterogeneous adult presentations and supports interpreting aortomesenteric measurements together with compatible symptoms and evidence of duodenal obstruction.