Superior mesenteric artery syndrome: A tough nut to crack – A rare complication in the management of oligometastatic colorectal carcinoma

Abstract

The superior mesenteric artery (SMA) syndrome is a rare cause of intestinal obstruction. However, conditions associated with rapid weight loss, including malignancy, burns, bariatric surgery, and trauma, can precipitate the syndrome. Recognition of the syndrome requires a high index of suspicion and a multidisciplinary approach in conjunction with the radiologist. Here, we present the case of a patient with metastatic colon cancer, who developed symptoms of abdominal pain and hematuria after undergoing a local ablative procedure for liver metastases. He was extensively evaluated, in view of a history of abdominal pain in the supine position and relieved in the prone position, along with a history of similar complaints following an earlier colectomy procedure and a history of weight loss. In view of this unusual symptom complex coupled with the radiologic findings on the ultrasound, he underwent a barium swallow which showed duodenal dilation and a reduced aortomesenteric angle. Thus, a diagnosis of the SMA syndrome with the nutcracker phenomenon was made. The patient was managed conservatively and is on regular follow-up. The case highlights the need for a multidisciplinary approach, with an innocuous observation in tandem with the clinical history being pivotal in clinching a rare diagnosis.