Superior mesenteric artery syndrome in a patient with esophageal stenosis: A case report

Abstract

BACKGROUND

Superior mesenteric artery syndrome (SMAS) is a rare condition, characterized by duodenal obstruction caused by compression of its third part by the superior mesenteric artery (SMA). Most cases of SMAS are associated with weight loss, and the most frequent clinical manifestations are nausea, vomiting, postprandial fullness, and abdominal pain. Treatment of SMAS is usually conservative, consisting mainly of adequate nutritional support, but in refractory cases surgery may be necessary, with gastrojejunostomy and duodenojejunostomy being the most commonly performed procedures.

CASE SUMMARY

We describe the case of a man in his forties with a pre-existing diagnosis of esophageal stricture due to sodium hydroxide ingestion, who suffered significant weight loss after replacement of his jejunostomy tube. He was admitted to the hospital due to pain and abdominal distension. A computerized tomography scan showed significant distension of the stomach and duodenum with narrowing of the duodenum at the point at which it is crossed by the superior mesenteric artery, thus establishing the diagnosis of SMAS. Due to the presence of the esophageal stricture, the patient was incapable of emesis; however, passage of a nasogastric tube for decompression was not possible. Considering the risk of gastric perforation due to distention, we opted for surgical treatment in the form of a surgical gastrojejunostomy after which he showed complete resolution of all symptoms and was discharged from the hospital 5 d after the procedure.

CONCLUSION

Diagnosis of SMAS can be challenging in patients with esophageal stenosis, and risk of gastric perforation may preclude conservative treatment.

Keywords: Superior mesenteric artery syndrome; Duodenal obstruction; Wilkie’s syndrome; Esophageal stricture; Esophageal stenosis; Case report

Core Tip: We report a rare case of superior mesenteric artery syndrome (SMAS) in a patient with pre-existing esophageal stricture. SMAS is a rare condition that is characterized by duodenal obstruction caused by the compression of its third part by the superior mesenteric artery. While no current evidence-based guidelines to determine ideal treatment for SMAS are available, an initial attempt at conservative treatment with nutritional support aiming at weight gain is indicated in most cases. However, SMAS may present differently in patients with esophageal strictures as the risk of gastric perforation due to ineffective gastric decompression must be considered and may favor early surgical treatment.