Conservative treatment of superior mesenteric artery syndrome.

Autores de IIS La Fe

• Maria Martinez Diaz

  Autor

• Miguel Couselo Jerez

  Autor

• Estíbaliz Valdés Diéguez

  Autor

• Vicente Ibáñez Pradas

  Autor

Grupos

• Hepatología experimental y Trasplante hepático

Abstract

OBJECTIVE: To assess predictive factors for failure in the conservative treatment of patients with superior mesenteric artery syndrome (SMAS). MATERIAL AND METHODS: A retrospective case-control study was carried out. Cases included pediatric patients diagnosed with SMAS and treated in our institution from 2013 to 2024. Controls included surgically treated SMAS patients under 20 years of age from a PubMed bibliographic review. Of a total of 205 papers, 24 met inclusion criteria. Demographic, clinical, diagnostic, therapeutic, and progression variables were collected. Statistical analysis was performed using chi-square/Fisher and Mann-Whitney U tests. RESULTS: N=42 (16 cases and 26 controls). No statistically significant differences were found in terms of BMI (17.25 vs. 14.43; U=148.5; p=0.398), progression time (130 vs. 90 days; U=176.0; p=0.820), angle (19° vs. 14.1°; U=159.0; p=0.206), or aortomesenteric distance (3.5 cm vs. 4.25 cm; U=62.5; p=0.068). Cases received conservative treatment, except for one who refused this treatment modality. There were no significant differences regarding final BMI (18.6 vs. 17.9; U=96.0; p=0.560), treatment success, or hospital stay (7.0 vs. 6.0 days; U=168.0; p=0.308) between both groups. CONCLUSIONS: Conservative treatment is highly successful regardless of progression time, BMI, angle, and aortomesenteric distance. Therefore, surgery is not recommended as the first option in the management of SMAS. OBJETIVO: Evaluar factores predictivos de fracaso del tratamiento conservador en pacientes con sindrome de la pinza aorto-mesenterica (PAM). METODO: Estudio retrospectivo de casos y controles. Los casos incluyeron pacientes pediatricos diagnosticados de PAM entre 2013 y 2024 tratados en nuestro centro. Los controles fueron pacientes con PAM, menores de 20 anos y tratados quirurgicamente, extraidos de una revision bibliografica en PubMed. De un total de 205 articulos, se seleccionaron 24 que cumplian con los criterios de inclusion. Se recogieron variables demograficas, clinicas, diagnosticas, terapeuticas y evolutivas. El analisis estadistico se realizo mediante las pruebas de Chi2/Fisher y U de Mann-Whitney. RESULTADOS: N=42 (16 casos y 26 controles). No se observaron diferencias estadisticamente significativas en el IMC (17,25 vs. 14,43; U=148,5; p=0,398), tiempo de evolucion (130 vs. 90 dias; U=176,0; p=0,820), angulo (19° vs. 14,1°; U=159,0; p=0,206) ni distancia aorto-mesenterica (3,5 cm vs. 4,25 cm; U=62,5; p=0,068). Los casos recibieron tratamiento conservador, salvo uno por rechazo del mismo. No hubo diferencias significativas en el IMC final (18,6 vs. 17,9; U=96,0; p=0,560), exito del tratamiento, ni estancia hospitalaria (7,0 vs. 6,0 dias; U=168,0; p=0,308) entre ambos grupos. CONCLUSIONES: El tratamiento conservador muestra un alto indice de exito independientemente del tiempo de evolucion, IMC, angulo y distancia aorto-mesenterica, por lo que se desaconseja la cirugia como opcion inicial en el manejo del sindrome de PAM.

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Keywords

• Conservative treatment; Superior mesenteric artery syndorme