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• W3208375797 abstract "Introduction: Superior mesenteric artery syndrome (SMAS) is a rare condition that develops from compression of the duodenum between the superior mesenteric artery (SMA) and abdominal aorta. SMAS is an atypical complication of restrictive eating disorders. We report a case of SMAS caused by anorexia nervosa. Case Description/Methods: A previously healthy 18-year-old female presented with abdominal pain, distension, and vomiting. Symptoms began a year prior and followed meals. She reported a 15-pound weight loss attributed to strenuous exercise. Vital signs were remarkable for BMI of 15.5 kg/m2 and sinus bradycardia of 40 beats per minute. Abdomen exam was remarkable for distension, and diffuse tenderness to palpation. Abdominal computed tomography (CT) revealed a markedly distended stomach and distended duodenal sweep (Figure 1A, B). Upper GI series showed narrowing of the distal duodenum with delayed contrast progression (Figure 1C). CT angiography after nasogastric tube decompression revealed a narrow angle of the SMA in relation to the aorta, with compression of the transverse duodenum (Figure 1D). Push enteroscopy was normal. Our patient was diagnosed with SMAS. She was evaluated by Psychiatry. Her strenuous exercise, restrictive diet, weight loss, and anxiety met criteria for anorexia nervosa. She received peripheral parenteral nutrition and IV thiamine. Her symptoms improved. Discussion: We report a severe case of SMAS due to anorexia nervosa. The SMA is supported by adipose tissue to create an aortomesenteric angle of 25-60 degrees.1 A reduction in adipose tissue causes narrowing of this angle.2 SMAS develops when the aortomesenteric angle is narrow enough that it compresses the distal duodenum passing through.1 Patients present with abdominal pain, distension, nausea, vomiting, and weight loss.3 In patients with restrictive eating disorders or rapid weight loss who present with obstructive symptoms, it is important to remember the association with SMAS to prevent delay of diagnosis and serious complications.Figure 1.: A) Coronal abdomen and pelvic CT image demonstrating a markedly distended stomach measuring 24.48 by 11.70 cm with distended duodenal sweep into the mid abdomen with possibility of obstruction. B) Sagittal abdomen and pelvic CT image demonstrating the SMA (white arrow) in relation to the aorta (black arrow) and the steep angle between them. C) Upper gastrointestinal series revealing a caliber change involving the distal duodenum that is relatively narrower than the more proximal distended duodenum. There was delayed antegrade progression of contrast through this region of the duodenum. D) Abdomen and pelvic CT with angiography demonstrating an acute angle between the SMA (white arrow) to the aorta (black arrow) with narrowing of the transverse duodenum, findings suspicious for superior mesenteric artery syndrome." @default.
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• W3208375797 date "2021-10-01" @default.
• W3208375797 modified "2023-10-17" @default.
• W3208375797 title "S3061 Superior Mesenteric Artery Syndrome in an Adolescent Female With Anorexia Nervosa" @default.
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• W3208375797 doi "https://doi.org/10.14309/01.ajg.0000785776.30275.70" @default.
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