Superior mesenteric artery syndrome in a healthy active adolescent

Abstract

This report discusses a case of superior mesenteric artery (SMA) syndrome in a previously healthy 15-year-old boy with no weight loss or other common risk factors. The patient presented to the emergency department with acute bilious vomiting and epigastric pain after acute consumption of a meal and excessive quantities of water. The patient was diagnosed with SMA syndrome based on the findings of contrasted CT of the abdomen. In early puberty, boys have a significant increase in lean body mass and a concomitant loss of adipose tissues. These pubertal changes lead to a narrowing of the aortomesenteric space. The acute consumption of food and water caused a transient obstruction at the already-narrowed space, which resulted in the manifestation of SMA syndrome. This case demonstrates that pubertal growth spurt is a risk factor for SMA syndrome, and acute excessive ingestion can trigger SMA syndrome among those in puberty.

Wilkie’s Weight Loss Wonder: A Case Series

“…However, other conditions (i.e., anatomical, surgical, pubescent) may predispose aortomesenteric angle decreases as well. [2][3][4][5][6] Congenital SMAS is very rare, with only a small number of patients being diagnosed in the medical literature. Congenital SMAS occurs due to an abnormal anatomical placement of the ligament of Treitz.…”

“…8 SMAS can even be seen in adolescents undergoing growth spurts, due to a significant increase in lean body mass, linear growth and loss of adipose tissues. 4 SMAS can primarily be identified through imaging modalities such as barium studies and computer tomography. The first line therapy consists of conservative nutritional support and promotion of weight gain.…”

“…1 Abnormal gastrointestinal anatomy, corrective spinal surgery, and pediatric growth spurts have all been described causing SMAS as well. [2][3][4][5][6] Conditions causing rapid weight loss (e.g., anorexia nervosa, malabsorption, and cancer) can each decrease the fat pad cushion, leading to SMAS. 2 Common presenting complaints include less specific gastrointestinal obstruction symptoms, such as nausea, vomiting, early satiety (i.e., "feeling full") and postprandial (i.e., after meal) pain.…”

“…1 SMAS is rare, with a reported prevalence of less than 0.3% among adults. 4 Furthermore, the varying etiology and overlapping symptomatology with other gastrointestinal pathologies (i.e., gastroesophageal reflux disease, mesenteric ischemia, biliary colic, peptic ulcer disease, intestinal volvulus) can make diagnosing SMAS quite difficult. 4 Maintaining a high clinical index of suspicion can lead to earlier diagnosis, allowing for conservative treatments to be more effective.…”

“…4 Furthermore, the varying etiology and overlapping symptomatology with other gastrointestinal pathologies (i.e., gastroesophageal reflux disease, mesenteric ischemia, biliary colic, peptic ulcer disease, intestinal volvulus) can make diagnosing SMAS quite difficult. 4 Maintaining a high clinical index of suspicion can lead to earlier diagnosis, allowing for conservative treatments to be more effective. The following outlines two recent cases of SMAS diagnosed at the authors' institution that were successfully treated with conservative management.…”