Sma Syndrome- A Rare Phenomenon

Abstract

Introduction: Superior Mesenteric Artery (SMA) syndrome is a rare digestive condition. It happens when the top artery of the mesentery presses on the third part of the duodenum. It leads to obstructive features. It often comes from fast weight loss that removes fat padding around the blood vessels. The main symptoms of SMA are pain in the upper belly after eating, early satiety, vomiting, fast and heavy weight loss, feeling better when lying on the side or pulling knees to the chest.

Case report: A twenty-three-year-old female patient presented to our hospital with diffuse abdominal pain postprandially for last three months. She was admitted and on the day admission, her routine blood work, including amylase, lipase, liver function tests and serum IgATTG antibody test for ruling out wheat allergy was unremarkable. Abdominal ultrasound showed no gallstones, pancreatitis, or free fluid. Pain persisted despite analgesics. Symptoms intensified postprandially, manifested by sharp epigastric pain after meals, without vomiting or diarrhea. An endoscopy under sedation was non-contributory. In view of diagnostic dilemma, we ordered contrast- enhanced CT (CECT) of the whole abdomen. The report, demonstrated dilatation of D2-D3 segment with abrupt narrowing of D3, as it is crossing under SMA with aorto-mesenteric angle of 13.2 degrees and aorto-mesenteric distance of 2.48 mm. The final impression given by radiologist was SMA syndrome. The patient was managed symptomatically with proton pump inhibitors, dietary modification (small, frequent meals), and pain medication, but symptoms persisted. Finally, the patient was referred to a gastro surgeon for further management.

Conclusion: SMA syndrome is rare phenomenon but should be always kept in differentia diagnosis of refractory pain abdomen, especially post -prandial one. It is diagnosed on radiological investigations