Superior mesenteric artery syndrome following colorectal surgery: a systematic review.

Background: Superior mesenteric artery syndrome (SMAS) is a rare characterized by obstruction of the third portion of the duodenum due to compression of this region between the superior mesenteric artery (SMA) and aorta. Diagnosis of SMAS post-surgical procedures is challenging due to nonspecific symptoms. Methods: In accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines, five electronic databases were systematically searched of all case reports published on SMAS diagnosed after colorectal procedures up to October 2023. The primary search of the databases revealed a total of 70 published articles. Thirty-eight studies were included. Aim: to discuss the prevalence of SMAS post-colorectal surgery, possible causes, preventive measures and best management options. Results: Total proctocolectomy with ileal J-pouch anal anastomosis was the most commonly reported surgical procedure (41.6%) preceding the diagnosis. Onset of symptoms since the primary operation had a wide range 1 day to >10 years. With a significant relation ( Limitations: Our study was limited by a small sample size, the retrospective nature of data collection, variability in patient populations, surgical techniques, and postoperative care protocols across the included studies, and short follow-up periods. Discussion: Majority of patient with SMAS following a colorectal surgery had successful conservative management (62.9%) within the time frame of 2-4 weeks (78.5%), while most reported patients with more extended conservative period eventually resorted to surgical management. Conclusion: While conservative management is usually effective, surgical intervention should always be considered if there is no improvement within 4 weeks. Future research should focus on larger prospective studies to validate these findings and explore additional predictors of treatment success.