ABSTRACT

Introduction: Superior mesenteric artery (SMA) syndrome is a rare clinical entity caused by acute angulation of SMA and abdominal aorta resulting in duodenal obstruction in its third part. Its association with complicated peptic ulcer disease is rare. Although the global incidence of peptic ulcer disease and its complications has decreased in the last few decades, it is still prevalent in low or middle socioeconomic countries like India. We present a rare association of gastric outlet obstruction (GOO) caused by complicated peptic ulcer disease (PUD) and SMA syndrome in an adolescent patient. Case presentation: An 18-year-old boy presented with mild upper abdominal pain, recurrent non-bilious vomiting, and severe weight loss for two years. The esophago-gastro-duodenoscopy (EGD) revealed pin-point pylorus, suggesting GOO. Contrast-enhanced computed tomography showed a decrease in aorto-mesenteric angle with compression of the third part of the duodenum and simultaneous stricture in the first part of duodenum giving a dumbbell appearance of dilated duodenum and stomach. He underwent duodenojejunostomy and Roux-en-Y gastrojejunostomy. Conclusion: Though SMA syndrome is rare, it should be considered in cases of upper intestinal obstruction. The coexistence of PUD related GOO with SMA syndrome is extremely rare and is the first of its kind reported in the literature. Keywords: Superior mesenteric artery syndrome, Gastric outlet obstruction, Peptic ulcer disease, Duodenal obstruction
Publication date: 01/08/2022

https://ijbpas.com/pdf/2022/August/MS_IJBPAS_2022_6238.pdf

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https://doi.org/10.31032/IJBPAS/2022/11.8.6238