144 Superior mesenteric artery syndrome: case report RC Shukla and R Pathak Department of Radiodiagnosis and Imaging, BHU, Varanasi, India Corresponding author: Dr. Roshani Pathak, Department of radiodiagnosis and Imaging, BHU, India e-mail:drroshanipathak@yahoo.co.in ABTRACT Superior mesenteric artery (SMA) syndrome is a rare acquired disorder in which acute angulation of SMA causes compression of the third part of the duodenum between the SMA and the aorta, leading to obstruction. Loss of fatty tissue as a result of a variety of debilitating conditions is believed to be the etiologic factor causing the acute angulation. We report a case of 30 years old lady who presented with postprandial abdominal pain at the epigastric region, colic type without radiation accompanied by nausea, postprandial vomiting and weight loss. Esophageal gastric series revealed an abrupt interruption in the contrast medium flow at the level of the junction of third portion (midpart) of the duodenum in barium studies. A diverticula is noted just proximal to the site of obstruction. High resolution ultrasound and color Doppler sonography showed narrowing of the aortomesenteric angle to 22 0 . Duodenojejunostomy was performed in the patient. Unfortunately the patient later was admitted in the hospital for refractory gastroparesis associated with superior mesenteric artery syndrome. Although open and laparoscopic duodenojejunostomy have been described as the best surgical treatment options for Wilkie’s syndrome, but further attention is needed to the management of patients with refractory symptoms of gastroparesis after corrective surgery. Keywords: Superior mesenteric artery syndrome, Wilkie’s syndrome, arteriomesentric duodenal compression. INTRODUCTION Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction. 1 It was first described by Von Rokitansky in 1842 and popularised later by Wilkie. It is also known as SMA syndrome, cast syndrome and arteriomesenteric duodenal compression. 2 SMA syndrome is a rare entity in which the third part of duodenum is compressed by the SMA, causing acute or chronic duodenal obstruction. It is seen in patients with rapid weight loss, those in plaster body casts, hip spica casts, or in traumatic quadriplegias, in which there may be sudden loss of weight and patient may be positioned supine for prolonged periods. 3 CASE REPORT A 30 years old lady, presented with postprandial abdominal pain at the epigastric region, colicky type without radiation, accompanied by nausea, postprandial vomiting and weight loss. She was treated in terms of tuberculosis before she came to this hospital. All blood tests including serum electrolytes and liver function tests were normal. Esophageal gastric series revealed an abrupt interruption in the contrast medium flow at the level of the junction of third portion (midpart) of the duodenum in barium studies (Fig 1). A diverticula is noted just proximal to the site of obstruction (Fig 1). High resolution ultrasound and color Doppler sonography showed narrowing of the aortomesenteric angle to 22 0 (Fig 2. a. and 2. b.). A diagnosis of Wilkie’s syndrome was made on the basis of clinical suspicion, upper GI barium studies, high resolution USG and color Doppler findings. Duodenojejunostomy was performed in the patient. Unfortunately the patient later was admitted in the hospital with the symptoms of refractory gastroparesis associated with superior mesenteric artery syndrome. DISCUSSION Superior mesenteric artery syndrome is a rare condition. Only 400 cases have been reported so far. 4 The Superior Fig. 1. An abrupt interruption in the contrast medium flow at the level of the junction of third portion (midpart) of the duodenum in barium studies along with a diverticulum just proximal to the site of obstructio Case Report Nepal Med Coll J 2008; 10(2): 144-145