Superior mesenteric artery syndrome in a patient with anorexia nervosa

A Case Report

Abstract

Superior mesenteric artery (SMA) syndrome occurs with an estimated incidence rate of 0.1% to 0.3%. Patients with this condition typically present with non-specific signs and symptoms such as epigastric pain, nausea, and vomiting – making its clinical diagnosis difficult.

This is a case of a 39-year-old Filipino female with an acute presentation of epigastric pain and abdominal bloatedness. A history of restrictive eating pattern with frequent self-induced vomiting associated with rapid and sudden onset of weight loss were disclosed, the symptoms of which were consistent with anorexia nervosa. Esophagogastroduodenoscopy was done which showed presence of retained food particles at the body and antrum of the stomach. Contrast-enhanced CT scan of the abdomen revealed a narrowing of the aortomesenteric distance, with an aortomesenteric angle measuring 22.2°, indicating the presence of SMA syndrome. Her symptoms resolved with gradual introduction of frequent feedings in addition to fluid and electrolyte correction.

SMA syndrome may be rare, but should be included in the differential diagnoses of patients presenting with sudden or acute abdominal pain. A high index of suspicion is needed to facilitate workup for its diagnosis. When left untreated, a cycle of abdominal pain and vomiting occurs, leading to further weight loss and aggravation of the condition.

Keywords: Superior mesenteric artery syndrome, Anorexia nervosa, Case report