Superior mesenteric artery syndrome misdiagnosed and preceded by helicobacter pylori-induced gastritis: a rare diagnosis with misleading features

Abstract

Introduction and Importance: Superior mesenteric artery syndrome is a rare morbid vascular disorder that is defined as the decreasing in the aortomesenteric angle and the compression of the third part of the duodenum. This disorder mainly affects young adult females, and severe weight loss represents a leading predisposing factor. Case presentation: We report the case of a 19-year-old male who was admitted to our hospital with a three-months history of epigastric pain, nausea, and weight loss. Two months earlier, the patient was diagnosed with helicobacter pylori-induced gastritis. Nevertheless, with complaints of severe headache and epigastric pain, the patient was admitted to our hospital for further investigations. Computed tomography scan with intravenous contrast injection was performed, and interestingly, the aortomesenteric angle was 19 degrees accompanied by a compression of the third part of the duodenum, and a mild gastric dilatation. Accordingly, the diagnosis was confirmed as a superior mesenteric artery syndrome. Clinical Discussion: In our case, the non-specific clinical symptoms correlated with histopathological examinations led to the initial diagnosis of Helicobacter Pylori-induced gastritis. Surprisingly, the lack of improvements led to performing CT scan, which confirmed the diagnosis of SMA syndrome. Subsequently, HP gastritis played a significant role in misleading and delaying the diagnosis. Conclusion: We report the first case report from Syria of s superior mesenteric artery syndrome that was misdiagnosed and preceded by HP-induced gastritis, highlighting the crucial role of detailed clinical and radiological examinations in the diagnosis of challenging cases with morbid complications.