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Superior mesenteric artery syndrome

Case contributed by Abdelmonem Mahmoud
Diagnosis probable

Presentation

Persistent vomiting.

Patient Data

Age: 65 years
Gender: Male

Markedly dilated, fluid and gas-filled stomach and pylorus.

Reduced aortomesenteric angle (15°) and aortomesenteric distance (2 mm). 

Compressed third part of the duodenum (paper like thickness) in-between Aorta and SMA.

Case Discussion

The diagnosis of SMA syndrome is based on clinical symptoms and radiologic evidence of gastric outlet obstruction.

In this case, there is an acute exacerbation of chronic symptoms; persistent vomiting for two days, not responding to medical treatment.

Chronic stomach dilatation is evident in prior ultrasound examination which revealed huge dilated stomach and pylorus showing to- and fro- movement of digested content, suggesting gastric outlet obstruction, with no evidence of wall compression by masses, jejunum and ileum show average transverse diameter, average wall thickness, with no evidence of dilatation.

CT and ultrasound findings which are suggesting gastric outlet obstruction due to compressed third part of the duodenum in-between Aorta and SMA, in addition to history of long-standing vague abdominal symptoms, early satiety, and anorexia, recurrent episodes of abdominal pain and vomiting, favors the diagnosis.

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