Superior mesenteric artery syndrome in a middle-aged woman

Introduction: The superior mesenteric artery (SMA) syndrome is an uncommon cause of proximal small bowel obstruction resulting from compression of the third part of the duodenum by the SMA. Various medical conditions may lead to a rapid weight loss and narrowing of the aortomesenteric angle. The clinical manifestations may include a variety of nonspecific symptoms ranging from postprandial epigastric pain to severe nausea and bilious emesis.

Patient: A 54-year-old woman presented with a 1-year history of epigastric pain, nausea, bloating and belching after eating and an acidic reflux. There was no vomiting. She had no appetite and had lost 13kg. She had had a cerebral infarction and was treated for depression. She had drunk alcohol regularly. She had sought medical advice during this period and had undergone a specialist gastroenterologist review and endoscopy. The laboratory test findings were unremarkable; both CEA and CA 19–9 were negative. Erosive pangastritis with thickened gastric folds and reflux disease was diagnosed. Big particle biopsy revealed Menetrier's syndrome. Proton pump inhibitor and prokinetic treatment had relieved her symptoms temporally. Abdominal CT indicated the thickening of both the tail of the pancreas and the gastric wall. EUS showed a normal pancreas, but enormous widening (12mm) of the muscularis propria of the antrum. The barium meal identified the obstruction of the third part of the duodenum. CT-enterography revealed reductions of both the aortomesenteric angle and the aortomesenteric space. Hence, all 3 diagnostic criteria of the SMA syndrome were met. The syndrome was probably caused by a previous weight loss due to the patient's depression and alcoholism. Surgical treatment was recommended.

Conclusion: The SMA syndrome should be considered as a potential diagnosis in patients with persistent postprandial abdominal symptoms and weight loss.