Superior Mesenteric Artery Syndrome Accompanied by Acute-onset Type 1 Diabetes Complicated with Graves' Disease

Abstract

A 35-year-old man experienced general fatigue and could not eat solid food because of nausea and vomiting. His weight abruptly decreased from 49 to 45 kg after 2 weeks. A detailed examination indicated superior mesenteric artery syndrome (SMAS) accompanied by acute-onset type 1 diabetes complicated by Graves' disease, referred to as autoimmune polyglandular syndrome type 3A (APS3A). Although SMAS has a good prognosis, some cases require emergency surgery, especially when complicated by gastric perforation. In our case, APS3A and SMAS developed rapidly and at approximately the same time, resulting in a cycle of mutual exacerbation.

Acute superior mesenteric artery syndrome complicated by severe gastric, pancreatic and renal ischaemia

“…The proposed aetiology of SMAS is thought to be secondary to factors that decrease the aortomesenteric angle, including severe/rapid weight loss, extra/intra-abdominal compression and mesenteric tension. SMAS has been observed with increased frequency in patients with eating disorders such as anorexia and bulimia, as well as in other cases of rapid weight loss—such as thyrotoxicosis 1 6 7. There have also been many cases of SMAS in patients who have recently undergone surgical intervention for spinal deformity—resulting in a decreased aortomesenteric angle and inducing duodenal constriction 5.…”