Advertisement

Superior Mesenteric Artery Syndrome

Open AccessPublished:May 22, 2022DOI:https://doi.org/10.1016/j.gastha.2022.05.008
      A 52-year-old Caucasian man with history of severe emphysema, chronic pulmonary nocardiosis, and severe protein-calorie malnutrition, presented to the emergency room with mild abdominal pain and postprandial vomiting for a month. He reported 40 pounds weight loss over 8 months with current body mass index of 13.8 kg/m2. On examination, an emaciated man with a distended abdomen with succussion splash was noted. A computed tomography angiogram of the abdomen (Figure A) showed marked dilation of the stomach, first and second part of the duodenum with obstruction of the third portion of the duodenum (arrow), as it crosses the spine between the aorta and superior mesenteric artery (SMA). An aorta-SMA angle of 11.7° was noted at the point of obstruction (Figure B, arrows), consistent with superior mesenteric artery syndrome. After nasogastric tube decompression, postpyloric nasojejunal tube feeding was started. He was discharged in stable condition for outpatient follow-up.