Behçet’s disease (BD) is a multisystemic, chronic autoimmune inflammatory vasculitic disease with an unknown etiology. Although the literature reports that vascular involvement occurs in 7% to 38% of all BD cases, the arteries are rarely involved; however, arterial involvement is usually associated with significant mortality and morbidity. We report the case of a young female patient who presented to the emergency department with severe abdominal pain and a history of weight loss. The patient was evaluated using computed tomography angiography, which revealed a ruptured suprarenal aortic pseudoaneurysm with occlusion of both the superior mesenteric and celiac arteries. Urgent surgery was performed with aortic repair with an interposition graft and superior mesenteric artery embolectomy. The patient’s clinical history and radiological imaging findings were strongly suggestive of the diagnosis of BD with vascular involvement.
Abdominal Pain ; Aneurysm, False ; Angiography ; Arteries ; Behcet Syndrome ; Celiac Artery ; Diagnosis ; Embolectomy ; Emergency Service, Hospital ; Female ; Humans ; Mesenteric Artery, Superior ; Mortality ; Transplants ; Vasculitis ; Weight Loss

Bariatric surgery is the most effective and durable treatment for morbidly obese patients. However, there are remained unsolved problems with various types of complications. Superior mesenteric artery syndrome is a rarely known condition occurred following bariatric surgery. We experienced 54-year-old female patient diagnosed with superior mesenteric artery syndrome 5 year later after laparoscopic adjustable gastric banding. Because symptoms have not improved with conservative care, laparoscopic duodenojejunal bypass was successfully performed for this patient.
Bariatric Surgery ; Female ; Humans ; Mesenteric Artery, Superior ; Middle Aged ; Superior Mesenteric Artery Syndrome

Introduction: Superior mesenteric artery (SMA) syndrome is a rare and unusual acquired cause of functional duodenal obstruction whose diagnosis can be easily missed without knowledge of this condition. Case Presentation: We report a case of a 27-year-old female, presenting with post-prandial vomiting, early satiety, bloatedness and weight loss for about 10 months. Vital signs were stable. She was grossly underweight with a BMI of 11.72 kg/m2 (height=1.6m, weight=30kg). Physical examination was unremarkable. Gastrointestinal series revealed a narrowing in the third portion of the duodenum likely secondary to extrinsic compression. Contrast-enhanced CT scan of the whole abdomen was performed with 3D reconstruction. There were no definite signs of gastrointestinal obstruction. However, a narrow/acute aorto-mesenteric angle of 13 degrees compressing the third part of the duodenum was noted. Superior mesenteric syndrome was considered, prompting further work-up. Primary hyperthyroidism was the root cause of the patient’s weight loss that lead to this condition. Patient was given nutritional support, parenterally and enterally. She was discharged improved after oral feeding was tolerated and patient started to gain weight. Discussion: Superior mesenteric artery (SMA) syndrome is an uncommon medical condition brought about by a decrease in the aortomesenteric angle from the usual 45o to less than 15o resulting in vascular compression of the third part of the duodenum leading to gastrointestinal obstruction. A high index of suspicion is needed to prevent the diagnosis from being missed which may in turn lead to unnecessary testing and treatment. If recognized early, the condition may be managed conservatively. Surgical management is only required when conservative methods fail. Conclusion Early recognition and a thorough evaluation is therefore imperative so conservative measures can be maximized at the outset.
Superior Mesenteric Artery Syndrome

Nutcracker syndrome is a phenomenon that the left renal vein (LRV) is pressed between the superior mesenteric artery (SMA) and the aorta. Clinical characteristics include gross or microscopic hematuria, orthostatic proteinuria, abdominal pain, and back pain. It occurs due to LRV squeezing caused by narrowed aortomesenteric angle. SMA syndrome is a disease that the third part of the duodenum is prone to intestinal obstruction by narrowed angle between the SMA and the abdominal aorta. Clinical symptoms include postprandial abdominal distension, epigastric pain, nausea, and vomiting. SMA syndrome and nutcracker syndrome have common features that result from narrowed aortomesenteric angle. However, it is very rare for both syndromes to occur simultaneously, so the two syndromes are regarded as separate diseases. This is a report on a case of nutcracker syndrome with SMA syndrome in a child who presented gross hematuria, recurrent abdominal pain and vomiting. To our knowledge, nutcracker syndrome simultaneous with SMA syndrome has not been previously reported in pediatric patient, especially with an exhibition of gross hematuria. This case suggests that the simultaneous presence of SMA syndrome with the same pathogenesis needs to be considered when nutcracker syndrome is suspected in pediatric patients with hematuria.
Abdominal Pain ; Aorta ; Aorta, Abdominal ; Back Pain ; Child ; Duodenum ; Hematuria ; Humans ; Intestinal Obstruction ; Mesenteric Artery, Superior ; Nausea ; Proteinuria ; Renal Veins ; Superior Mesenteric Artery Syndrome ; Vomiting

Cases of repeated acute gastric dilatations after binge eating in one patient are rarely reported. We report here a case of repeated acute gastric dilatations in a 22-year-old woman with bulimia nervosa. Her repeated acute gastric dilatations seem to have been related to superior mesenteric artery syndrome. On her last visit due to acute gastric dilatation, she underwent emergency gastric decompression surgery because of abdominal compartment syndrome; however, she eventually died because of ischemia reperfusion injury. Emergency physicians should be aware of the need to manage acute gastric dilatation in patients with eating disorder and should pay attention to the signs and distinctive clinical features of abdominal compartment syndrome.
Bulimia Nervosa* ; Bulimia* ; Decompression ; Dilatation* ; Eating ; Emergencies ; Female ; Gastric Dilatation ; Humans ; Intra-Abdominal Hypertension* ; Reperfusion Injury ; Superior Mesenteric Artery Syndrome ; Young Adult

Superior mesenteric artery (SMA) syndrome is one of the rare causes of small bowel obstruction. It develops following a marked decrease in the angle between SMA and the abdominal aorta due to weight loss, anatomical anomalies, or following surgeries. Nutcracker syndrome in the left renal vein may also occur following a decrease in the aortomesenteric angle. Though SMA syndrome and renal nutcracker syndrome share the same pathogenesis, concurrent development has rarely been reported. Herein, we report a 23-year-old healthy male diagnosed with SMA syndrome and renal nutcracker syndrome due to severe weight reduction. The patient visited our outpatient clinic presenting bilious vomiting and indigested vomitus for 3 consecutive days. He had lost 20 kg during military service. We suspected SMA syndrome based on abnormal air-shadow in the stomach and small bowel on abdominal X-ray; we confirmed compression of the third portion of the duodenum with upper gastrointestinal series and abdominal computed tomography (CT). Concurrently, renal nutcracker syndrome was also detected via abdominal CT and Doppler ultrasound. Considering bilious vomiting and no urinary symptoms, SMA syndrome was corrected by laparoscopic duodenojejunostomy, and close observation for the renal nutcracker syndrome was recommended.
Ambulatory Care Facilities ; Aorta, Abdominal ; Duodenum ; Humans ; Intestinal Obstruction ; Laparoscopy ; Male* ; Mesenteric Artery, Superior* ; Military Personnel ; Renal Nutcracker Syndrome* ; Renal Veins ; Stomach ; Superior Mesenteric Artery Syndrome* ; Tomography, X-Ray Computed ; Ultrasonography ; Vomiting ; Weight Loss ; Young Adult

Superior mesenteric artery (SMA) syndrome is a rare condition that must be differentiated from other gastrointestinal diseases manifesting as upper abdominal pain, nausea, or vomiting. The description of SMA syndrome is compression of the third portion of the duodenum by the SMA and the abdominal aorta. SMA syndrome is managed with nasoenteral nutrition or surgical strategies such as laparoscopic duodenojejunostomy. However, SMA syndrome treated using enteral nutrition by percutaneous radiologic gastrojejunostomy has not been reported. Here, we report our experience of successfully managing a case of SMA syndrome with percutaneous radiologic gastrojejunostomy.
Abdominal Pain ; Aorta, Abdominal ; Duodenal Obstruction ; Duodenum ; Enteral Nutrition ; Gastric Bypass* ; Gastrointestinal Diseases ; Mesenteric Artery, Superior* ; Nausea ; Superior Mesenteric Artery Syndrome* ; Vomiting

A 16-year-old Chinese male patient presented with constipation lasting five days, colicky abdominal pain, lethargy, weakness and body aches. He was able to pass flatus. Abdominal radiography showed a distended stomach causing inferior displacement of the transverse colon. Computed tomography revealed a dilated oesophagus, stomach and duodenum up to its third portion, with a short aortomesenteric distance and narrow angle. There was also consolidation in the lungs bilaterally. Based on the constellation of clinical and imaging findings, a diagnosis of superior mesenteric artery syndrome complicated by aspiration pneumonia was made. The patient was subsequently started on intravenous hydration, nasogastric tube aspiration and antibiotics. Following stabilisation of his acute condition, a nasojejunal feeding tube was inserted and a feeding plan was implemented to promote weight gain. The clinical presentation, differentials, diagnosis and treatment of superior mesenteric artery syndrome are discussed.
Adolescent ; Aged ; Child ; China ; Duodenum ; diagnostic imaging ; Enteral Nutrition ; Fluoroscopy ; Gastrointestinal Tract ; diagnostic imaging ; Humans ; Male ; Mesenteric Arteries ; diagnostic imaging ; physiopathology ; Pneumonia, Aspiration ; diagnostic imaging ; Radiography, Abdominal ; Superior Mesenteric Artery Syndrome ; diagnostic imaging ; Syndrome ; Tomography, X-Ray Computed ; Vomiting ; diagnostic imaging

Acupuncture Therapy ; Adolescent ; Humans ; Male ; Superior Mesenteric Artery Syndrome ; therapy

Abdominal Pain ; diagnosis ; Adult ; Female ; Humans ; Sports ; Superior Mesenteric Artery Syndrome ; diagnosis ; Young Adult