Superior Mesenteric Artery Syndrome: An Uncommon Cause of Abdominal Pain Mimicking Gastric Outlet Obstruction
A 42-year-old female patient presented with abdominal pain and vomiting after every meal since 3 months. The pain was colicky in nature relieved on lying down on left lateral position. Patient had history of weight loss of about ten kilogram in the last 3 months; she weighed 30 kg and looked cachexic. She had past history for appendicular perforation 3 years back for which she was operated.\nLaboratory investigations revealed PCV - 46%, Hb - 11.1 g/dl, MCV - 71.63 cu.mm (80-90) - microcytic, total leucocytes count of 11,400 cu.mm with Neutrophils - 62%. Upper gastrointestinal endoscopy was attempted however probe could not be negotiated through third part of duodenum. Barium meal follow through showed dilated proximal duodenum with linear vertical filling defect across proximal third part of duodenum was suggestive of SMA syndrome [Figures -]. A provisional diagnosis of SMA syndrome was made. For further investigation patient was advised computed tomography (CT) scan, however patient could not afford it.\nA nasogastric tube was inserted and the patient was started on parenteral nutrition. Conservative measures failed, and 1 week later the patient was subjected to laparotomy, where dilatation of the duodenum proximally to the superior mesenteric vessels was observed. The third part of the duodenum was exposed and mobilized and a loop duodenojejunostomy was performed, approximately 10 cm distally to the ligament of Treitz. Her post-operative course was uneventful.