Volume 29, Issue 163, September 2025

The Association Between Excessive Weight Loss and the Development of Superior Mesenteric Artery Syndrome - A Systematic Review of Recent Evidence

Marta Urszula Marciniak^1♦, Marta Tortyna¹, Julia Sztubińska¹, Danuta Borowska¹, Julia Urbańska¹, Paula Szarek², Olga Samsel¹, Natalia Sioch¹, Julia Krotofil¹, Maciej Trzciński¹, Kamil Nieczaj¹

¹Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
²Faculty of Medicine and Health Sciences, Collegium Medicum of the University of ZielonaGóra, Zielona Góra, Poland

^♦Corresponding author
Marta Urszula Marciniak, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland

ABSTRACT

Superior Mesenteric Artery Syndrome (SMAS), is a rare but potentially serious condition resulting from compression of the third portion of the duodenum between the superior mesenteric artery and the abdominal aorta. A significant reduction in retroperitoneal fat due to excessive weight loss most often precipitates this compression. This systematic review demonstrates the association between excessive weight loss and SMAS. It also gives an overview of the etiology, symptoms, diagnosis, and treatment options. The authors used the PubMed and Google Scholar databases to search for articles published between 2020 and the present. Fitting studies for this article include systematic reviews and case reports that describe patients with excessive body weight loss (defined as ≥5% in 6–12 months), characterizing clinical presentation, diagnosis, and treatment resultants. Most of the patients who had been diagnosed with SMAS had experienced excessive weight loss, primarily as a result of eating disorders (e.g., anorexia nervosa). The most frequent symptoms are postprandial abdominal pain, nausea, vomiting, and early satiety. Clinicians typically make the diagnosis based on computed tomography, which reveals a narrow aortomesenteric angle (<25o) and a short aortomesenteric distance (≤8 mm). Most patients demand only conservative treatment such as nutritional support. Nonetheless, more involved presentations ultimately need operative management, with duodenojejunostomy being the surgery of choice. To summarize, the diagnosis of superior mesenteric artery syndrome may endanger life when a recent past of substantial weight reduction coincides with vague bowel symptoms. Swift verification of the pathology, paired with prompt surgical correction, remains essential for averting sequelae.

Keywords: Superior Mesenteric Artery, SMAS, Excessive weight loss

Medical Science, 2025, 29, e194ms3643

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DOI: https://doi.org/10.54905/disssi.v29i163.e194ms3643

Published: 30 September 2025