Saudi Journal of Gastroenterology
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Year : 2013  |  Volume : 19  |  Issue : 4  |  Page : 190-191
An intriguing cause of intractable nausea and vomiting


1 Department of Medicine, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
2 Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

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Date of Web Publication4-Jul-2013
 

How to cite this article:
Girotra M, Shah HR, Rego RF. An intriguing cause of intractable nausea and vomiting. Saudi J Gastroenterol 2013;19:190-1

How to cite this URL:
Girotra M, Shah HR, Rego RF. An intriguing cause of intractable nausea and vomiting. Saudi J Gastroenterol [serial online] 2013 [cited 2019 Nov 13];19:190-1. Available from: http://www.saudijgastro.com/text.asp?2013/19/4/190/114510


A 60-year-old lady with history of reflux disease and breast cancer status post-lumpectomy and lymph node dissection followed by chemotherapy and now in remission, was admitted with progressively increasing nausea and vomiting of 2 months duration. She also described episodic epigastric abdominal pain, which increased on food intake and led to vomiting, which brought her instant relief. She had lost about 80 lbs of weight during her chemotherapy, which stabilized for few months but was now again falling because of her inability to eat. There was no alteration in bowel habits, fever or any other associated symptoms. She had two previous admissions for similar problems at a local hospital where symptomatic relief was achieved with dobhoff tube placement. She had been tolerating the tube feeds well, however, for last 2 days her symptoms reappeared raising concern of obstructed dobhoff and hence a gastroenterologist was consulted for endoscopic evaluation. Her blood-work was normal. Barium swallow showed extrinsic compression of the 3 rd portion of duodenum, at the level of superior mesenteric artery (SMA) crossing, causing partial obstruction as barium passes through the 3 rd to 4 th portion [Figure 1]. Computed tomography (CT) scan was obtained which was diagnostic [Figure 2].
Figure 1: Barium swallow: Extrinsic compression of the 3rd portion of duodenum, at the level of superior mesenteric artery crossing, causing partial obstruction as barium passes through the 3rd to 4th portion

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Figure 2: An aorta-SMA angle of less than 25° is considered diagnostic of SMA syndrome

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Esophagogastroduodenoscopy revealed a patent 3 rd part of duodenum.


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Q1. What is the diagnosis?



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   References Top

1.Derrick JR, Fadhli HA. Surgical anatomy of the superior mesenteric artery. Am Surg 1965;31:545-7.  Back to cited text no. 1
[PUBMED]    
2.Raman SP, Neyman EG, Horton KM, Eckhauser FE, Fishman EK. Superior mesenteric artery syndrome: Spectrum of CT findings with multiplanar reconstructions and 3-D imaging. Abdom Imaging 2012;37:1079-88.  Back to cited text no. 2
    
3.Merrett ND, Wilson RB, Cosman P, Biankin AV. Superior mesenteric artery syndrome: Diagnosis and treatment strategies. J Gastrointest Surg 2009;13:287-92.  Back to cited text no. 3
    
4.Neto NI, Godoy EP, Campos JM, Abrantes T, Quinino R, Barbosa AL, et al. Superior mesenteric artery syndrome after laparoscopic sleeve gastrectomy. Obes Surg 2007;17:825-7.  Back to cited text no. 4
    
5.Biank V, Werlin S. Superior mesenteric artery syndrome in children: A 20-year experience. J Pediatr Gastroenterol Nutr 2006;42:522-5.  Back to cited text no. 5
    

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Correspondence Address:
Mohit Girotra
Department of Medicine, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Shorey S8/68, Mail Slot # 567 Little Rock, AR
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.114510

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