Superior mesenteric artery syndrome caused by acute weight loss in a 16-year-old polytrauma patient: A rare case report and review of the literature

Abstract

Introduction Superior mesenteric artery syndrome is a rare entity, caused by compression of the duodenum between the superior mesenteric artery and the aorta. Case presentation A 16-year-old male in the inpatient service of our hospital complained of vomiting for two weeks. The patient had a long hospital stay in our center for the management of trauma-related complications, which resulted in significant weight loss despite the parenteral nutrition as he was unable for taking the enteral nutrition due to severe facial traumatic injury. In oral contrast study, the proximal duodenal segments were dilated. The contrast media could not reach the duodenojejunal junction in the supine position, though a small amount of the contras passed the distal duodenal part on repositioning the patient to prone. On abdominal CT images, the angle and distance between the superior mesenteric artery and the abdominal aorta were decreased to 20. 8 0 , and 7.3 mm respectively. The findings were consistent with the superior mesenteric artery compression syndrome. He underwent a mini-laparotomy for the placement of a jejunostomy feeding tube aiming to promote weight gain and mesenteric fat restoration for preventing the SMA compression effects on the duodenum. Discussion The decrease in retroperitoneal fat owing to weight loss may result in aortomesenteric angle reduction and duodenal compression. Prompt nutritional support and timely diagnosis may preclude the need for more invasive surgical intervention. Conclusion Superior mesenteric artery syndrome is a rare condition, often resulting in small bowel obstruction. The clinical symptoms of this syndrome are nonspecific, which may underestimate the diagnosis. However, clinical suspicion supported by imaging study may help the accurate diagnosis. Superior mesenteric artery syndrome should be considered in all polytrauma and longstanding immobile patients present with rapid weight loss and vomiting.

Superior Mesenteric Artery Syndrome, a Rare Complication of Severe Malnutrition: Two Cases from a Subsaharian Endocrinology Department

“…A low origin of the SMA or an abnormally high origin of the Treitz ligament is important congenital causes of SMAS. The loss of retroperitoneal fat due to, for example, polytrauma, burns, eating disorders, major surgical procedures, and cast immobilization, causing a reduction in the aortomesenteric angle, are the main acquired aetiological factors for SMA compression syndrome [12]. Severe malnutrition was present in both of our patients.…”

“…However, hepatic steatosis and axonal polyneuropathy could be complications of this malnutrition [13] [14]. Axonal polyneuropathy could also be related to vasculitis or systemic disease [15], which are also sources of malnutrition and SMAS due to hypercatabolism [12]. Management is initially medical, consisting of inserting a nasogastric tube to decompress the stomach and duodenum, placing the patient in the left lateral position, and, above all, compensating for hydroelectrolytic disorders and introducing a high-calorie diet.…”

Superior Mesenteric Artery Syndrome: Delayed Diagnosis of a Rare Clinical Entity With a Common Clinical Presentation

“…Symptoms normally comprise postprandial abdominal pain involving the epigastric region associated with early satiety, nausea, vomiting, bloating, burping, reflux, and abdominal distension. These symptoms are usually precipitated after meals which can lead to further weight loss [ 6 ].…”

COVID-19 infection with severe hypocalcaemia and superior mesenteric artery syndrome—a case report

“…Treatment options include nutritional support for adequate weight gain and regrowth of the mesenteric fat pad and subsequently improvement in the aortomesenteric angle ( 9 ). Symptomatic relief can be opted with postural therapy (prone, knee-chest or left lateral position) or placement of a nasogastric tube, which aids by restoring the aortomesenteric distance, allowing enteral feeding and subsequently weight gain, and eventually relieving the obstruction ( 5 , 9 ). Finally, surgical intervention such as gastrojejunostomy, duodenojejunostomy, or division of the ligament of Treitz can be performed in severe cases with failure of conservative management ( 8 ).…”