Related Experiment Videos
Superior mesenteric artery syndrome in traumatic brain injury: two cases
M J Pedoto1, M W O'Dell, M Thrun
1Department of Physical Medicine and Rehabilitation, University of Cincinnati College of Medicine, Drake Center, Inc., OH, USA.
Insights
Superior Mesenteric Artery Syndrome (SMAS) can cause enteral feeding intolerance in adults with traumatic brain injury (TBI). Early recognition and conservative treatment can resolve SMAS, improving nutrition in TBI patients.
Area of Science:
- Neuroscience
- Gastroenterology
- Critical Care Medicine
Background:
- Enteral feeding (EF) intolerance is a common complication following traumatic brain injury (TBI).
- Superior Mesenteric Artery Syndrome (SMAS), a condition where the duodenum is compressed by the superior mesenteric artery (SMA) against the aorta, is a recognized cause of EF intolerance, particularly in pediatric TBI.
- SMAS is infrequently reported in adult TBI patients, potentially leading to underdiagnosis.
Observation:
- This report details two adult patients who developed SMAS after severe TBI.
- Risk factors for SMAS, including acute weight loss, prolonged recumbency, and spasticity, are frequently present in severe TBI cases.
- The patients experienced EF intolerance secondary to SMAS.
Findings:
- SMAS in adult TBI patients is characterized by duodenal compression due to SMA-aorta impingement.
- Conservative management, including gastric decompression and nutritional support (e.g., feeding in specific positions, hyperalimentation, or feeding tube repositioning), led to symptom resolution.
- Weight gain was achieved through these conservative measures, indicating successful treatment.
Implications:
- SMAS should be considered in the differential diagnosis of EF intolerance in adult patients with severe TBI.
- Increased awareness of SMAS in this population may improve diagnostic rates and patient outcomes.
- Prompt recognition and management of SMAS can mitigate nutritional deficits and improve recovery in TBI patients.
Abstract:
One of the many causes of enteral feeding (EF) intolerance after traumatic brain injury (TBI) is superior mesenteric artery syndrome (SMAS). Although it is reported in pediatric brain injury, few cases are noted in adults. To increase awareness of this medically treatable condition, we present two patients who developed SMAS after sustaining severe brain injury. SMAS results from compression of the duodenum by the SMA against the aorta and risk factors include acute weight loss, prolonged recumbency, and spasticity--all frequently encountered in severe TBI. After gastric decompression, symptoms often resolve with weight gain achieved by conservative treatment; including feeding in the left lateral or prone position, hyperalimentation, or extension of a feeding tube beyond the obstruction. SMAS should be considered in the presence of EF intolerance in severe adult TBI because multiple risk factors may be present.