This review is directed at increasing awareness of two diverse rare upper gastrointestinal
problems that occur at opposite ends of the age spectrum and are difficult to diagnose and treat. The
Superior Mesenteric Artery Syndrome (SMAS) likely involves a young patient, especially female,
and is especially associated with rapid weight loss, resulting in relative strangulation of the duodenum
by a narrowing of the angle between the Superior Mesenteric Artery (SMA) and the aorta. On
the other hand, atherosclerosis of the SMA is associated most likely with postprandial upper intestinal
ischemia and abdominal pain occurs in the elderly at high risk for cardiovascular (CV) disease.
Medical management of the SMAS in the young involves good alimentation and weight gain to
overall increase the intestinal fat pad. Medical management of SMA atherosclerotic ischemia in the
elderly is directed at marked lipid lowering with atherosclerotic plaque stabilization or even regression.
If needed, surgery for SMAS can be attempted laparoscopically with duodenojejunoscopy which is
the most popular procedure but there are also more conservative possibilities that avoid division of
the duodenum. In addition, sometimes direct vision is needed to successfully operate on SMAS. If
surgery is needed for SMA atherosclerotic ischemia, it is usually attempted endoscopically with angioplasty
and stent placement.
Most important, in the case of these two rare clinical entities, is that the clinician have a suspicion of
their presence when indicated so that the young or old patient can be spared unnecessary suffering
and return to good health in a timely fashion.