Abstract

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.