Abstract
Background Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction leading to acute kidney injury (AKI). Methods We report a case of 23-year-old army personnel who presented with persistent vomiting leading to severe hypokalaemia, metabolic alkalosis, and acute kidney injury resulting in cardiorespiratory arrest. Results After successful resuscitation, he was supported with haemodialysis and aggressive electrolytes correction. He was repeatedly not able to tolerate nasogastric (NG) tube feeding and computerised tomography of abdomen was performed, and the diagnosis of SMA syndrome was made. Gastroscopy examination revealed duodenal ulcer at D1, pinhole D1-D2 junction, but there was no evidence of intraluminal mass or lesions leading to upper gastrointestinal obstruction. A nasojejunal tube was inserted to bypass the narrow segment of the duodenum, and he was put on nutritional support. He was subsequently weaned off dialysis support as his renal function gradually improved and later on normalised. He remains symptoms free, and he gained five kilograms in four months after discharge. Conclusions SMA syndrome is a rare cause of upper gastrointestinal obstruction but should be considered as a differential diagnosis in a patient who presented with recurrent vomiting and AKI with metabolic alkalosis.
Highlights
Superior mesenteric artery (SMA) syndrome is one of the rare causes of upper gastrointestinal (GI) obstruction with reported a very low prevalence of 0.013–0.3% [1, 2]
Apart from the loss of retroperitoneal fat tissue due to progressive weight loss for past one year that probably attributed to his vigorous physical training, resultant to intermittent vomiting, computerised tomography (CT) scan, and gastroscopy examination with biopsy ruled out any local cause such as tumours that could contribute to the narrowing of the aortomesenteric angle
SMA syndrome is rare but should be considered as a differential diagnosis when a patient presents with recurrent vomiting and acute kidney injury (AKI) with metabolic alkalosis
Summary
Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction leading to acute kidney injury (AKI). He was supported with haemodialysis and aggressive electrolytes correction He was repeatedly not able to tolerate nasogastric (NG) tube feeding and computerised tomography of abdomen was performed, and the diagnosis of SMA syndrome was made. A nasojejunal tube was inserted to bypass the narrow segment of the duodenum, and he was put on nutritional support He was subsequently weaned off dialysis support as his renal function gradually improved and later on normalised. SMA syndrome is a rare cause of upper gastrointestinal obstruction but should be considered as a differential diagnosis in a patient who presented with recurrent vomiting and AKI with metabolic alkalosis
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