Korean J Gastroenterol.  2011 Nov;58(5):280-283. 10.4166/kjg.2011.58.5.280.

A Case of Superior Mesenteric Artery Syndrome Caused by Anorexia Nervosa

• Lee CW
• Park MI
• Park SJ
• Moon W
• Kim HH
• Kim BJ
• Shim IK
• Park SS

• KMID: 1026371
• DOI: http://doi.org/10.4166/kjg.2011.58.5.280

Abstract

Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by compression of the third segment of the duodenum by the mesenteric artery at the level of the SMA, resulting in duodenal dilatation. Precipitating factors of the SMA syndrome include prolonged bed rest, weight loss, abdominal surgery, and increased lordosis of the spine. We report a case of SMA syndrome caused by anorexia nervosa in a 15-year-old adolescent girl. CT and an upper gastrointestinal contrast series revealed partial obstruction of the third portion of duodenum and decreased aortomesenteric distance. The patient's symptoms were successfully treated with total parental nutrition and psychiatric treatment including supportive, cognitive behavioral therapy and antidepressant medication. This case shows that SMA syndrome is an unusual gastrointestinal complication that may occur in patients with anorexia nervosa.

Keyword

Superior mesenteric artery syndrome; Anorexia nervosa

MeSH Terms

Adolescent
Anorexia Nervosa/*complications
Antidepressive Agents/therapeutic use
Cognitive Therapy
Endoscopy, Gastrointestinal
Female
Fluoxetine/therapeutic use
Humans
Parenteral Nutrition, Total
Superior Mesenteric Artery Syndrome/*diagnosis/*etiology/therapy
Tomography, X-Ray Computed

Figure

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  Fig. 1. Endoscopic findings. (A) Partial obstruction of the third portion of duodenum was observed. (B) Bile lake was observed in the stomach.

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  Fig. 2. Upper gastrointestinal contrast study findings. (A) It showed dilatation of the second portion of duodenum and blocked barium passage with a cut-off sign in the third portion of the duodenum. (B) It showed the improved passage after position change from supine to knee-chest position.

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  Fig. 3. Abdominal CT finding. It showed dilatation of the second portion of duodenum, and a compression of the third portion of duodenum between the aorta and superior mesenteric artery (arrow indicates the aortomesenteric distance, 0.74 mm).

Reference

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