Abstract
Superior mesenteric artery (SMA) syndrome occurs due to compression of the third portion of duodenum as it crosses anterior to aorta at the level of L3 vertebral body. We report a case of 40 year old female, who presented with recurrent bilious vomiting of 3 months duration and significant weight loss. Clinical examination revealed features of proximal small bowel obstruction. Contrast enhanced computed tomography showed reversed SMA-SMV axis and encircling of the proximal jejunal loops surrounding the superior mesenteric artery with possible diagnosis of malrotation with intermittent volvulus. However, barium meal follow through with corroborative ultrasound Doppler revealed features suggestive of superior mesenteric artery syndrome. Intraoperatively, a short thick ligament of Treitz was found with no features of malrotation. The ligament of Treitz was released, roux-en-Y duodenojejunal bypass surgery was done.
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