Presentation
Repeated attack of vomiting.
Patient Data
Markedly dilated stomach and proximal duodenum.
Marked dilatation of the stomach and proximal duodenum with a cut-off point at 3rd part of the duodenum as it compressed between the aorta and SMA.
Narrow both aorto-mesenteric distance and angle.
Collapsed distal bowel loops.
Case Discussion
Oral contrast shows dilated stomach and proximal duodenum filled with contrast.
CT scan of the abdomen reveals an obstruction point at the third part of the duodenum which narrowed and compressed between the aorta and SMA.
Measuring the aorto-mesenteric angle and distance revealed markedly narrowed about 6 degrees and 3.2 mm distance respectively, finding consisted of superior mesenteric artery syndrome.
The mottled appearance of the stomach was confirmed to be residual food particles by endoscopy.
The surgeon decided to continue with conservative management (NG tube for decompression plus electrolyte correction with diet modification and advised the patient to try to get more weight to increase aortomesenteric distance) with close follow for patient symptoms before proceeding to surgical intervention.