The so-called superior mesenteric artery syndrome.

Ever since Von Rokitansky1suggested in 1861 that it may be the superior mesenteric vessels that compress and obstruct the duodenum over the lumbar spine, generations of surgeons have regularly rediscovered this observation. I did so almost 20 years ago, and recently this cycle has been repeated.2 There are patients with chronic or intermittent duodenal dilation and stasis, without evidence of any mechanical obstruction. The explanation for this is obscure. Argument continues every few years as to the cause of chronic duodenal ileus and as to the most effective treatment. Symptoms and Diagnosis The patient is often a female teenager or someone in her early 20s who has a past history of "bilious attacks." More recently, she may have lost weight or had a spinal fusion operation. Even the application of a body cast may precipitate the condition. In 1878, Willett3wrote of fatal vomiting after application