Barros LCTR, Santos BMRTD, Ferreira GSA, Gomes VMDS, Vieira LPB. Superior mesenteric artery syndrome in a patient with esophageal stenosis: A case report. World J Surg Proced 2022; 12(2): 13-19 [DOI: 10.5412/wjsp.v12.i2.13]
Corresponding Author of This Article
Gustavo de Sousa Arantes Ferreira, MD, MSc, Surgeon, Teacher, Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Estrada Parque Contorno do Bosque, S/N, Brasilia 70658-700, Distrito Federal, Brazil. gustferr@ufmg.br
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Surg Proced. Nov 24, 2022; 12(2): 13-19 Published online Nov 24, 2022. doi: 10.5412/wjsp.v12.i2.13
Superior mesenteric artery syndrome in a patient with esophageal stenosis: A case report
Luise Cristina Torres Rubim de Barros, Barbara Moreira Ribeiro Trindade dos Santos, Gustavo de Sousa Arantes Ferreira, Vitoria Mikaelly da Silva Gomes, Lorenna Paulinelli Bahia Vieira
Luise Cristina Torres Rubim de Barros, Barbara Moreira Ribeiro Trindade dos Santos, Vitoria Mikaelly da Silva Gomes, Lorenna Paulinelli Bahia Vieira, Department of General Surgery, Hospital de Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte 31710350, Minas Gerais, Brazil
Gustavo de Sousa Arantes Ferreira, Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Brasilia 70658-700, Distrito Federal, Brazil
Gustavo de Sousa Arantes Ferreira, Lorenna Paulinelli Bahia Vieira, Department of General Surgery, Hospital Metropolitano Doutor Celio de Castro, Belo Horizonte 30620090, Minas Gerais, Brazil
Author contributions: Gomes VMS and Ferreira GSA designed the report; Barros LCTR, Santos BMRT, and Ferreira GSA collected the patient’s clinical data, analyzed the data, and wrote the paper; Barros LCTR and Vieira LPB reviewed the paper.
Informed consent statement: Written informed consent was obtained from the patient.
Conflict-of-interest statement: All the authors declare no conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gustavo de Sousa Arantes Ferreira, MD, MSc, Surgeon, Teacher, Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Estrada Parque Contorno do Bosque, S/N, Brasilia 70658-700, Distrito Federal, Brazil. gustferr@ufmg.br
Received: July 25, 2022 Peer-review started: July 25, 2022 First decision: August 22, 2022 Revised: October 12, 2022 Accepted: November 7, 2022 Article in press: November 7, 2022 Published online: November 24, 2022
Abstract
BACKGROUND
Superior mesenteric artery syndrome (SMAS) is a rare condition, characterized by duodenal obstruction caused by compression of its third part by the superior mesenteric artery (SMA). Most cases of SMAS are associated with weight loss, and the most frequent clinical manifestations are nausea, vomiting, postprandial fullness, and abdominal pain. Treatment of SMAS is usually conservative, consisting mainly of adequate nutritional support, but in refractory cases surgery may be necessary, with gastrojejunostomy and duodenojejunostomy being the most commonly performed procedures.
CASE SUMMARY
We describe the case of a man in his forties with a pre-existing diagnosis of esophageal stricture due to sodium hydroxide ingestion, who suffered significant weight loss after replacement of his jejunostomy tube. He was admitted to the hospital due to pain and abdominal distension. A computerized tomography scan showed significant distension of the stomach and duodenum with narrowing of the duodenum at the point at which it is crossed by the superior mesenteric artery, thus establishing the diagnosis of SMAS. Due to the presence of the esophageal stricture, the patient was incapable of emesis; however, passage of a nasogastric tube for decompression was not possible. Considering the risk of gastric perforation due to distention, we opted for surgical treatment in the form of a surgical gastrojejunostomy after which he showed complete resolution of all symptoms and was discharged from the hospital 5 d after the procedure.
CONCLUSION
Diagnosis of SMAS can be challenging in patients with esophageal stenosis, and risk of gastric perforation may preclude conservative treatment.
Core Tip: We report a rare case of superior mesenteric artery syndrome (SMAS) in a patient with pre-existing esophageal stricture. SMAS is a rare condition that is characterized by duodenal obstruction caused by the compression of its third part by the superior mesenteric artery. While no current evidence-based guidelines to determine ideal treatment for SMAS are available, an initial attempt at conservative treatment with nutritional support aiming at weight gain is indicated in most cases. However, SMAS may present differently in patients with esophageal strictures as the risk of gastric perforation due to ineffective gastric decompression must be considered and may favor early surgical treatment.
