Superior Mesenteric Artery Syndrome

Abstract

The patient was a 22-year-old woman with a 10-year history of anorexia nervosa restricting subtype who had been diagnosed with superior mesenteric artery (SMA) syndrome (Figure 1). She reported diffuse abdominal pain and nonvolitional vomiting shortly after food consumption, which was contributing to further weight loss. With nutritional rehabilitation, which initially included increased amounts of liquid supplements and eventual tolerance of a regular oral diet, she achieved a body mass index of 20.08 kg/m2, with near resolution of her gastrointestinal (GI) symptoms and computed tomography findings no longer meeting criteria for SMA syndrome (Figure 2).Figure 2After weight restoration (body mass index, 20.08 kg/m2; aortomesenteric distance, 4.72 mm; aortomesenteric distance, 8.05 mm). SMA = superior mesenteric artery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Superior mesenteric artery syndrome is a frequently overlooked cause of abdominal pain and emesis associated with food consumption in patients who have lost substantial weight. Superior mesenteric artery syndrome results from the compression of the horizontal duodenum between the SMA and the aorta owing to atrophy of the mesenteric fat pad resulting from weight loss. Diagnosis can be made functionally with upper GI series or with computed tomography angiography or magnetic resonance angiography; an aortomesenteric angle less than 25° or an aortomesenteric distance less than or equal to 8 mm are the most frequently cited diagnostic criteria.1Unal B. Aktaş A. Kemal G. et al.Superior mesenteric artery syndrome: CT and ultrasonography findings.Diagn Interv Radiol. 2005; 11: 90-95Google Scholar Patients may be referred for surgical intervention, but surgery should never be first-line treatment as duodenal compression and, hence, the GI symptoms resolve with even modest weight restoration and reconstitution of the mesenteric fat pad (see Figures 1 and 2).2Watters A. Gibson D. Dee E. Mascolo M. Mehler P.S. Superior mesenteric artery syndrome in severe anorexia nervosa: a case series.Clin Case Rep. 2019; 8: 185-189Google Scholar Options for nutritional rehabilitation can include increased liquid supplements, enteral nutrition bypassing the duodenal compression, or total parenteral nutrition in extreme cases. The patient was a 22-year-old woman with a 10-year history of anorexia nervosa restricting subtype who had been diagnosed with superior mesenteric artery (SMA) syndrome (Figure 1). She reported diffuse abdominal pain and nonvolitional vomiting shortly after food consumption, which was contributing to further weight loss. With nutritional rehabilitation, which initially included increased amounts of liquid supplements and eventual tolerance of a regular oral diet, she achieved a body mass index of 20.08 kg/m2, with near resolution of her gastrointestinal (GI) symptoms and computed tomography findings no longer meeting criteria for SMA syndrome (Figure 2). Superior mesenteric artery syndrome is a frequently overlooked cause of abdominal pain and emesis associated with food consumption in patients who have lost substantial weight. Superior mesenteric artery syndrome results from the compression of the horizontal duodenum between the SMA and the aorta owing to atrophy of the mesenteric fat pad resulting from weight loss. Diagnosis can be made functionally with upper GI series or with computed tomography angiography or magnetic resonance angiography; an aortomesenteric angle less than 25° or an aortomesenteric distance less than or equal to 8 mm are the most frequently cited diagnostic criteria.1Unal B. Aktaş A. Kemal G. et al.Superior mesenteric artery syndrome: CT and ultrasonography findings.Diagn Interv Radiol. 2005; 11: 90-95Google Scholar Patients may be referred for surgical intervention, but surgery should never be first-line treatment as duodenal compression and, hence, the GI symptoms resolve with even modest weight restoration and reconstitution of the mesenteric fat pad (see Figures 1 and 2).2Watters A. Gibson D. Dee E. Mascolo M. Mehler P.S. Superior mesenteric artery syndrome in severe anorexia nervosa: a case series.Clin Case Rep. 2019; 8: 185-189Google Scholar Options for nutritional rehabilitation can include increased liquid supplements, enteral nutrition bypassing the duodenal compression, or total parenteral nutrition in extreme cases. We thank Sara Nieder for her help in obtaining the images.