Superior Mesentric Artery Syndrome in a Patient with Subacute Intestinal Obstruction: A Case Repor t

Abstract

Superior Mesenteric Artery (SMA) syndrome is one of the rare cause of proximal small bowel obstruction wherein, the third part of the duodenum is compressed between the SMA at its origin and abdominal aorta due to decreased angulations in these two vessels. This decreased angulation exerts a compression effect on third part of the duodenum, resulting in duodenal obstruction which may be complete or partial. There are number of causes which can lead to this entity and will be discussed briefly. Here we report imaging findings of such a rare cause of proximal small bowel obstruction in a young male patient who presented to the emergency surgical department with non specific symptoms of pain abdomen and abdominal fullness. Patient was evaluated under the standard protocol in management of abdominal pain. General physical examination, erect and supine radiograph were taken. On barium meal follow-through examination, there was paucity of contrast agent distal to the second part of duodenum with proximal dilation of stomach, first and second part of duodenum which raised us the possibility of SMA syndrome. Reconstructed CECT abdomen confirmed the decreased angulation between SMA and abdominal aorta and diagnosed it as SMA syndrome. Findings were correlated on duodenojejunostomy anastomotic surgical procedure. Diagnosing and reporting such a case of SMA syndrome is of utmost importance because the clinical presentation being non-specific pertaining to small bowel obstruction which may pose a diagnostic difficulty to the surgeon and with the further delay in diagnosis, patients may end up with chronic symptoms and complications of the disease, repeated hospital visits and electrolyte abnormalities.

Assessment of the relationship between intraabdominal fat thickness and the aortomesenteric angle and distance using computed tomography

“…• -60 • and 10-28 mm, respectively 6,24 , and the results of the present study were consistent with the literature in terms of the aortomesenteric angle and aortomesenteric distance. The part of duodenum courses posteroinferiorly in relation to the SMA.…”

Superior mesenteric artery syndrome: A diagnosis to be kept in mind (Case report and literature review)

“…Third part of duodenum courses posteroinferior in relation to SMA. Any loss in retroperitoneal fat might reduce that angle and leads to superior mesenteric artery syndrome [2], [3].…”

Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice

“…Dehydration and electrolyte abnormalities due to prolonged vomiting are not uncommon. 5,[7][8][9] Diagnosis SMA syndrome is diagnosed through a combination of clinical history, examination and radiological imaging.…”