Increase body weight to treat superior mesenteric artery syndrome

• Published in: BMJ case reports 2017-06, Vol.2017, p.bcr-2017-219378
• Main Authors: Albano, Miguel Nico, Costa Almeida, Carlos, Louro, João Mendes, Martinez, Guillermo
• Format: Article
• Language: English
• Subjects: Abdomen; Anorexia; Anorexia Nervosa - complications; Anorexia Nervosa - diagnosis; Coronary vessels; Duodenal Obstruction - complications; Duodenal Obstruction - diagnosis; Duodenal Obstruction - etiology; Duodenum - blood supply; Duodenum - pathology; Eating disorders; Europe (West); Female; Gastrointestinal surgery; Humans; Medical imaging; Nutrition; Parenteral Nutrition, Total - methods; Patients; Rare Disease; Rare Diseases; Small intestine; Substance abuse treatment; Superior Mesenteric Artery Syndrome - diagnostic imaging; Superior Mesenteric Artery Syndrome - etiology; Superior Mesenteric Artery Syndrome - therapy; Tomography, X-Ray Computed; Treatment Outcome; Weight Gain - physiology; White; Young Adult
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2017-219378

IntroductionSuperior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction resulting from vascular compression of the third part of the duodenum in the angle between the abdominal aorta and SMA.Case presentationA 19-year-old woman with anorexia nervosa with upper gastrointestinal obstruction symptoms resorted to the emergency department. A diagnosis of SMA syndrome was made. Symptoms were solved with conservative treatment aimed at increase body weight.DiscussionSMA syndrome is most commonly associated with debilitating illnesses. Patients present with acute or insidious upper gastrointestinal obstruction symptoms. Aortomesenteric artery angle of ≤25° is the most sensitive measure of diagnosis. Advances in both enteral and parenteral nutrition led to a shift towards conservative treatment.ConclusionsLow threshold of suspicion is important to make a timely diagnosis and treatment. A conservative treatment aimed at increasing body weight is the first-line approach, leaving surgical intervention for failure cases.