Abstract
Superior mesenteric artery (SMA) syndrome is a rare clinical entity characterized by the compression of third part of the duodenum between the superior mesenteric artery and abdominal aorta due to loss of intervening mesenteric fat pad. This article reports a case of a patient operated for tubercular intestinal perforation following which she developed postprandial abdominal pain and recurrent vomiting in the postoperative period. Contrast enhanced computed tomography (CECT) of abdomen was done which showed gastric dilatation extending till the third part of duodenum with decreased aorto-mesenteric angle, compatible with the diagnosis of SMA syndrome. The patient was managed conservatively on total parenteral nutrition. Six weeks after the surgery, patient’s symptoms resolved completely on conservative management and recovered without any need of surgical intervention. This case illustrates the pathogenesis of SMA syndrome in the setting of severe weight loss caused by tuberculosis superimposed by the catabolic state of surgery leading to rapid loss of mesenteric fat which was successfully managed conservatively.
Highlights
Superior mesenteric artery (SMA) syndrome is a rare gastrointestinal disorder caused by the compression of third part of the duodenum between superior mesenteric artery and abdominal aorta
This article reports a case of SMA syndrome due to severe weight loss following surgery of tubercular intestinal perforation
The reason of SMA syndrome in our case is due to severe weight loss caused by tuberculosis superimposed by the catabolic state of surgery leading to loss of retroperitoneal fat
Summary
Superior mesenteric artery (SMA) syndrome is a rare gastrointestinal disorder caused by the compression of third part of the duodenum between superior mesenteric artery and abdominal aorta. This article reports a case of SMA syndrome due to severe weight loss following surgery of tubercular intestinal perforation. A 20-year-old woman presented to the emergency department with complaints of severe abdominal pain, multiple episodes of vomiting and obstipation for one day She was a known case of abdominal tuberculosis and had received anti-tubercular treatment for two months. The patient had multiple episodes of bilious vomiting with stoma output decreasing to less than 100 mL per day. Her abdomen remained flat with no increase in bowel sounds. A follow-up CECT was done after six weeks from discharge which showed an increase in aortomesenteric angle from 15° to 21° (Figure 3) with the patient being asymptomatic and a total weight gain of 12 kg postsurgery
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