Superior mesenteric artery syndrome

Case contributed by Dr Craig Hacking

Presentation

Fall, hip possible fracture on XR. Abdominal distension and generalised pain.

Patient Data

Age: 82
Gender: Female

Poor renal function precluded the use of IV contrast.

The oesophagus is fluid-filled and markedly gas-distended, the gastro-oesophageal junction is open and does not appear irregular or thickened. The stomach is markedly gas-distended extending into a dilated first and second part of duodenum tapering in D3 as the duodenum passes between the aorta and superior mesenteric artery. The small bowel distal to this is not dilated.

The distance between the superior mesenteric artery and aorta at the level of the third part of duodenum is 3 mm with an aortomesenteric angle of 17 degrees.

The rectum is thickly distended measuring 71 mm in diameter. Uncomplicated diverticular disease seen within the sigmoid colon. The appendix is normal in appearance. No free fluid or air identified. Indwelling bladder catheter.

The liver, spleen and adrenal glands are unremarkable within limitations of non-contrast CT followup. Fatty atrophy of the pancreas. Probable left renal inferior parapelvic cyst.

Interlobular septal thickening in the imaged lung bases likely secondary to pulmonary oedema.

No suspicious osseous lesion identified. Lumbar scoliosis convex to the right centred at L3. Degenerative changes seen within the lumbar spine. No fracture is identified.

Conclusion

  • No left neck of femur fracture identified.
  • Imaging features suggestive of left SMA syndrome, clinical correlation is recommended.
  • Gas and fluid distended stomach and oesophagus placing the patient at risk of aspiration.

Case Discussion

The patient was lost to follow up.

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Case information

rID: 34696
Case created: 5th Mar 2015
Last edited: 6th Jan 2016
Inclusion in quiz mode: Included

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