Superior mesenteric artery syndrome

Published:January 21, 2008DOI:
      A 19-year-old woman was admitted via the emergency department because of recurrent vomiting and weight loss. Three years before the current admission, she had presented with recurrent vomiting and weight loss, at which time the findings of abdominal US, upper endoscopy, abdominal CT scan, and magnetic resonance imaging were all normal. One year later she developed identical symptoms and another upper endoscopy was performed, which showed Helicobacter pylori infection that was then treated by a standard protocol. She remained symptom free for 2 years, and then 1 month before this admission was treated on an outpatient basis for recurrent vomiting. By the time of her admission 7 days later, she was dehydrated but well oriented and alert, with no abdominal tenderness; her weight on admission was 39 kg, and she had a body mass index of 15.2. Results of routine blood tests were normal, and a psychiatric evaluation ruled out anorexia and bulimia. A CT scan with vascular reconstruction revealed a small aortomesenteric angle (A). Upper GI series showed compression of the third portion of the duodenum that slowed the flow of barium at that level (B). Abdominal US showed a reduced aortomesenteric angle (C). The clinical history and imaging tests all supported the diagnosis of superior mesenteric artery (SMA) syndrome, and since gaining weight, the patient has become symptom free.
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