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

Int J Surg Case Rep. 2017:34:84-86. doi: 10.1016/j.ijscr.2017.03.018. Epub 2017 Mar 18.

Abstract

Introduction: Superior mesenteric artery (SMA) syndrome or what is called Wiklie's syndrome is one of the rare causes of small bowel obstruction. Its exact incidence is not known. It is due to decrease in Aortomesenteric angle.

Case presentation: A thirty-Four-year old male patient presented to our accident and emergency (department) with 3days history of epigastric pain, which was not radiating anywhere. It had no aggravating or relieving factors. Patient complained of repeated attack of vomiting as well. Contrast enhanced Computed tomography (CT) showed duodenal obstruction caused by superior mesenteric artery compression on 3rd part of duodenum.

Discussion: Superior mesenteric artery syndrome (SMA) is one of the rare causes of small bowel obstruction. Incidence of superior mesenteric artery syndrome reported in literature is ranging from 0.1 to 0.3%. The most common cause is significant weight loss which leads to loss of retroperitoneal fat. Treatment usually is conservative but surgical intervention should be considered if that failed.

Conclusion: Superior mesenteric artery syndrome is a rare cause of intestinal obstruction but should be kept in mind. Persistent vomiting after history of weight loss should raise the suspicion of this diagnosis. Upper GI endoscopy may be necessary to exclude mechanical causes of duodenal obstruction. Contrast enhanced CT scan is useful in the diagnosis of superior mesenteric artery syndrome and can provide diagnostic information.

Keywords: Aortomesenteric angle; Duodenal obstruction; Superior mesenteric artery (SMA) syndrome.