Superior mesenteric artery syndrome

Abstract

A 54-YEAR-OLD MAN presented to the emergency department with an acute exacerbation of episodic vomiting and epigastric pain. He admitted to a weight loss of 20 kg since the onset of symptoms 6 months earlier. His medical history was significant for substance abuse and chronic dementia with no history of previous abdominal surgery. The patient’s vital signs were stable and his abdomen was soft, distended, and nontender. The placement of a nasogastric tube was followed by the drainage of 1.5 L of bilious fluid. Laboratory data were within normal limits. A computed tomographic (CT) scan of the abdomen revealed complete obstruction of the third portion of the duodenum with marked proximal gastroduodenal distension (Fig 1). Also noted on the CT scan was compression of the left renal vein with a left varicocele. CT angiography revealed a diminished aortomesenteric angle of 228 (normal, 38–658) and distance of 8 mm (normal, 10–28 mm), confirming a diagnosis of superior mesenteric artery (SMA) syndrome (Fig 2). Esophagogastroduodenoscopy revealed no intrinsic duodenal pathology. A duodenojejunostomy was performed with an uneventful postoperative course. At 18 months postsurgery, the patient’s body weight had increased with complete resolution of the symptoms.