Korean J Gastrointest Endosc.  2010 Feb;40(2):121-125.

The Identification of Superior Mesenteric Artery Syndrome Established by Endoscopic Ultrasound in a Patient with Severe Gastroptosis

• Kim SJ
• Chung WC
• Jung SH
• Kwak JW
• Lee MH
• Paik CN
• Lee KM

Abstract

Superior mesenteric artery (SMA) syndrome is caused by compression of the transverse part of the duodenum between the SMA and the aorta, where the distance between these vessels decreases with loss of mesenteric fat. It occurs most frequently in patients with rapid weight loss. Conventionally, the diagnosis is established by digital fluoroscopy and contrast-enhanced spiral computed tomography (CT). A 17-year old woman was admitted via the emergency department with postprandial fullness, nausea, and bile stained vomiting. The initial radiological examination revealed severe gastroptosis. Fluoroscopic evaluation after barium swallowing failed due to a markedly distended stomach. The diagnosis of SMA syndrome was made by endoscopic ultrasound (EUS) using a mini-probe. EUS findings were in good agreement with the CT angiogram. A conservative trial was attempted, but symptoms remained refractory. Surgery was an alternative option and we treated the patient successfully with laparoscopic duodeno-jejunostomy.

Keyword

Superior mesenteric artery syndrome; Endoscopic ultrasound

MeSH Terms

Aorta
Barium
Bile
Deglutition
Duodenum
Emergencies
Female
Fluoroscopy
Humans
Mesenteric Artery, Superior
Nausea
Stomach
Superior Mesenteric Artery Syndrome
Tomography, Spiral Computed
Vomiting
Weight Loss
Barium