Nausea and Vomiting--Track And Field

Abstract

HISTROTY: 19 year old female cross-country runner with gastrointestinal symptoms progressing over the previous two months. Initially her symptoms began with nausea and crampy abdominal pain which occurred thirty minutes into her training runs with gradual progression to vomiting and diarrhea. Her symptoms were made worse by eating and increased intensity of exercise. She felt better when lying in the knee to chest position. She denied hematemesis, melena, or bright red blood per rectum. Her symptoms eventually progressed to nausea at rest. She had lost four pounds due to loss of appetite. Past medical history includes irritable bowel syndrome. Past surgical history includes a choledocal cyst resection as an infant. PHYSICAL EXAMINATION: Asthenic habitus, abdomen soft, nontender, nondistended, with normal bowel sounds. No masses or hepatosplenomegaly. No rebound or guarding. DIFFERENTIAL DIAGNOSIS: Irritable bowel syndrome. Peptic ulcer disease. Gastroesophageal reflux disease. Cholelithiasis. Bulemarexia Gastric outlet obstruction. TEST AMD RESULTS: Labs: Normal. KUB: Normal Upper GI series: Prominent dilation of second and third portions of the duodenum with transition zone identified at the junction of the third and fourth portions. Abdominal CT scan: Stomach distention with proximal dilation of the duodenum. Approximately 2–3 mm between superior mesenteric artey and aorta compressing the left renal vein and third portion of the duodenum. FINAL WORKING DIAGNOSIS: Superior mesenteric artery syndrome. TREATMENT AND OUTCOMES: She underwent laparotomy with release of the ligament of Treitz. She had persistent duodenal obstruction and duodenal bypass was performed. Her duodenal motility returned. She was discharged to home with eventual return to cross country free of gastrointestinal symptoms.