Superior mesenteric artery syndrome in thermally injured patients

In a 12-year period, 37 of 3,536 burn patients developed acute obstruction of the duodenum by the superior mesenteric artery. Nasogastric decompression and intravenous fluids were required initially in all 37 patients. Twelve patients received no further therapy, with resolution of the obstruction in six and death of the other six from burn wound sepsis or pneumonia. Ten patients underwent operative treatment consisting of either duodenojejunostomy (eight) or vagotomy and gastroenterostomy (two), with resolution in seven and three postoperative deaths. Fifteen patients were treated with intravenous hyperalimentation and gastric decompression, with resolution in 12 patients, one required operative intervention, and two died of complications. A high degree of suspicion followed by prompt diagnosis and treatment of the SMA syndrome are required in all critically ill patients with unexplained bilious vomiting. Gastric decompression coupled with aggressive use of intravenous hyperalimentation recently has reduced the need for operative treatment (42% versus 11%).