INTESTINAL OBSTRUCTION IN AN 18-YEAR-OLD FEMALE WITH SUPERIOR MESENTERIC ARTERY SYNDROME: CASE REPORT AND LITERATURE REVIEW
*Hibah A. Almahdi, Nada H. Mahmoud, Sultan Tawfiq and Fatema K. Al-Madani
Abstract
Introduction: Superior mesenteric artery (SMA) syndrome is
characterized by compressed third part of duodenum between SMA
and the abdominal aorta. According to literature review, the incidence
of SMA syndrome was estimated to be 0.013–0.3%. Case report: An
18-year-old female patient was presented to King Fahad Hospital with
15 days history of abdominal pain associated with recurrent
postprandial vomiting of gastric content and absolute constipation,
preceded by rapid weight loss of 12 kilograms. Her vitals were stable.
Laboratory investigations were normal except for Lactate
dehydrogenase and alanine aminotransferase which were slightly high.
Esophagogastroduodenoscopy showed stenosis. Enhanced CT abdomen and pelvis showed
distended stomach and duodenum proximal to the narrowed 3rd part of duodenum. Patient
was treated conservatively for 2 weeks and discharged in a good condition. Discussion: SMA
syndrome is a rare vascular cause of small bowel obstruction. Several factors play a rule in
narrowing the aorto-mesentric angle. Significant rapid loss of weight is the commonest cause.
Conservative approach should be attempted first in managing SMA syndrome. If
conservative management fails, surgical management is indicated. Conclusion: SMA
syndrome is a diagnosis that should be kept in mind in cases of high intestinal obstruction
especially with young patients who have history of recent weight loss. Enhanced CT is good
to establish the diagnosis of SMA syndrome. Sometimes mechanical obstruction causes
should be ruled out by Esophagogastroduodenoscopy.
Keywords: Superior mesenteric artery syndrome, Intestinal obstruction, rapid weight loss, absolute constipation, conservative.
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