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• W2914182671 abstract "Superior mesenteric artery (SMA) syndrome is defined as a compression of the third portion of the duodenum between the superior mesenteric artery and the aorta. When severe, this syndrome usually presents as a gastric outlet obstruction. Reversal of this syndrome after pregnancy is described in this case. A 38-year-old female presented to the emergency department with mid-epigastric pain and intractable vomiting. CT imaging revealed the presence of a massively dilated stomach and compression of the third portion of the duodenum consistent with SMA syndrome (Figure 1 - Arrow pointing to SMA, Star in dilated duodenum). Plans to surgically correct this anomaly were postponed when the patient became pregnant. The patient was followed by a high risk obstetric practice and had difficulty gaining appropriate weight. Despite supportive care, she had a low body mass index, low fetal weight, and worsening symptoms during her pregnancy. The patient was first seen by Gastroenterology when she was 24 weeks gestation. Following initial workup, surgical intervention was proposed due to persistent epigastric pain and inadequate weight gain. Feeding tube placement was also offered as an alternative treatment for weight difficulties however was not necessary as the patient eventually tolerated a sufficient liquid diet. Plans were made to postpone endoscopic evaluation and eventual surgical correction until after successful delivery of the fetus. Supportive care was sufficiently provided in the interim. Following delivery, both abdominal bloating as well as other obstructive symptomatology improved significantly. Repeat imaging showed no evidence of SMA syndrome (Figure 2, Arrow near SMA in the third duodenum). Endoscopy was also performed and supported the resolution of SMA syndrome. There are many complications that are associated with SMA syndrome, especially when it involves patients who are pregnant. Nutritional deficiencies that create difficulties with proper fetal growth and development have been associated with recurrent pregnancy loss. This case demonstrates the first known report of the resolution of SMA syndrome following pregnancy. While the mechanism is not completely known, one may hypothesize that some of the physiologic changes with pregnancy allowing smooth muscle relaxation naturally correct the obstructive angles seen with this syndrome. Additionally, shifting weights due to the growing fetus may also contribute to the resolution.Figure: Massively dilated stomach caused by gastric outlet obstruction. Red arrow pointing to SMA, star in dilated duodenum.Figure: Red arrow indicates normal caliber duodenum as it crosses midline. The stomach and proximal duodenum are normal in caliber after resolution of the SMA syndrome." @default.
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• W2914182671 date "2017-10-01" @default.
• W2914182671 modified "2023-09-25" @default.
• W2914182671 title "Reversal of Superior Mesenteric Artery Syndrome Following Pregnancy" @default.
• W2914182671 doi "https://doi.org/10.14309/00000434-201710001-02412" @default.
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