Superior Mesenteric Artery Syndrome in an Adolescent Female with Anorexia Nervosa

Abstract

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. The SMA is supported by adipose tissue to create an aortomesenteric angle that varies from 25-60 degrees. A reduction in adipose tissue causes narrowing of this angle, and SMAS develops when the aortomesenteric angle is narrow enough that it compresses the distal duodenum passing through. Patients present with small bowel obstructive symptoms. We report a severe case of SMAS in an adolescent female with anorexia nervosa who presented with acute and chronic symptoms of bowel obstruction. Awareness of the association between SMAS and restrictive eating disorders can help guide clinical decision-making and prevent delay of diagnosis and serious complications.

Superior Mesenteric Artery Syndrome in Anorexia Nervosa: A Case Report and a Systematic Revision of the Literature

“…In conclusion, 11 provided records included in the revision [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Diagram 1 presents the flow chart of the selection process, adapted from PRISMA guidelines ( Figure 4 ).…”

“…Diagnosing SMAS in a restrictive eating disorder is challenging, as symptoms such as vomiting and reduced food intake can be present in anorexia nervosa as well [ 7 ]. According to the literature, anorexia nervosa in adolescents presents with a severe restriction of food and energy intake, and the refusal of specific food finalizes in a significant reduction in body weight.…”

“…On the one hand, the research points out how superior mesenteric artery syndrome may be the result of a severe lowering in body mass index due both to weight loss and weight maintenance during growth and pubertal development, and on the other hand, other researchers have put forward the hypothesis that anorexia nervosa could instead be a possible consequence of this syndrome. Patients, for example, may develop a psychiatric aversion to food as a defensive formula against the organic difficulties encountered during nutrition and the disabling symptoms experienced after meals [ 7 , 14 , 15 ].…”

“…Furthermore, in some cases present in the literature, it has been highlighted that depressive and anxious symptoms are present during treatments and subsequently during follow-up [ 5 , 6 , 7 , 15 ]. These data, in correlation with the risky link between superior mesenteric artery syndrome and anorexia nervosa, suggest the importance of psychological support during and after hospitalization.…”

“…The choice of the type of support varies on the basis of the grade of obstruction and the patient’s tolerance [ 5 ]. Nutritional support is generally required in the initial stages of treatment because adequate nutritional support and gastric decompression contribute to the improvement of the symptoms [ 5 , 7 ]. For this purpose, enteral feeding via a nasal tube distal to the obstruction is usually chosen (50%).…”