SMA syndrome

Case contributed by Dr Andrew Dixon

Presentation

Malnutrition and vomiting.

Patient Data

Age: 50 years
Gender: Male
Barium

Markedly dilated stomach and proximal duodenum.

PO + IV contrast CT

CT

There is a markedly dilated stomach and proximal duodenum, with an abrupt cut-off at the point at which the superior mesenteric artery (SMA) crosses over the 3rd portion of the duodenum. Downstream small bowel is not dilated.

Case Discussion

Contrast follow-through shows markedly distended stomach and filling of the first and second parts of the duodenum.  An abrupt cut-off to contrast passage is seen in the third part of the duodenum.

CT with oral and intravenous contrast confirms that there is obstruction of the third part of the duodenum arguably due to a narrow angle between the SMA and the aorta.

These findings are consistent with SMA syndrome.

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