Presentation
Young diabetic man with intermittent abdominal pain
Patient Data
Extreme dilatation of the stomach and proximal duodenum with tapered narrowing of the 3rd part of the duodenum as it passes between the SMA and aorta. Decreased aortomesentric angle is noted. The findings are suggestive of SMA syndrome.
Case Discussion
Endoscopy reported luminal narrowing of the third segment of duodenum. The patient refused surgical intervention, so there is no diagnostic proof of this diagnosis.
SMA syndrome is one of the abdominal entrapment syndromes in which the third part of the duodenum is trapped as it passes between the aorta and superior mesenteric artery. The proximal parts of the duodenum and stomach are usually dilated in these patients. The aortomesenteric angle is less than 41 degrees and is best evaluated on sagittal images.