Abdominal pain-an uncommon cause

Superior Mesenteric Artery Syndrome: An Uncommon Cause of Abdominal Pain Mimicking Gastroenteritis

Abdominal pain and vomiting are frequently encountered in the emergency department. We report a 54-year-old man with an uncommon cause of intestinal obstruction – superior mesenteric artery syndrome – who presented with epigastric pain and vomiting. Diagnosis is clinical with radiological confirmation by upper gastrointestinal series or computed tomography scan. Most patients respond to conservative and supportive treatment. A minority may need surgical intervention.

Emergency department presentation of superior mesenteric artery syndrome: two cases in Marine Corps recruits

BACKGROUND

Superior mesenteric artery (SMA) syndrome is a relatively rare etiology of proximal intestinal obstruction. Obstruction results from marked narrowing of the angle between the SMA and aorta, causing compression of the third portion of the duodenum, most commonly as a result of precipitous weight loss. Intermittent non-specific symptoms at presentation often result in a delayed diagnosis, thus the importance of being aware of this condition.

OBJECTIVE

To familiarize emergency physicians with the presentation of SMA syndrome and discuss its diagnosis and management in the emergency department (ED).

CASE REPORT

We present two cases of SMA syndrome identified in Marine Corps recruits presenting to our ED.

CONCLUSION

Emergency physicians should include SMA syndrome in the differential diagnosis of abdominal pain and vomiting in individuals with predisposing factors.

Superior mesenteric artery syndrome after esophagectomy with cervical esophagogastrostomy

A 50-year-old man who underwent esophagectomy with cervical esophagogastrostomy for esophageal cancer presented with superior mesenteric artery syndrome. He had severe diffuse and dull abdominal pain and frequent vomiting that began within 10 days after the operation. He also complained of indigestion and early fullness, and lost more than 5 kg of body weight during the period. The symptoms were initiated by poor oral intake and weight loss, and were relieved by nutritional support. Although it is very rare, we conclude that surgeons and radiologists should be aware of the possibility of superior mesenteric artery syndrome as one of the complications after esophagectomy.