Clin Endosc.  2013 Jul;46(4):410-413.

Superior Mesenteric Artery Syndrome Diagnosed with Linear Endoscopic Ultrasound (with Video) in a Patient with Normal Body Mass Index

• Wee JW
• Lee TH
• Lee JS
• Kim WJ

Abstract

Superior mesenteric artery (SMA) syndrome is an uncommon disease that results from SMA compression of the third portion of the duodenum. Patients with SMA syndrome present with upper gastrointestinal symptoms, such as nausea, vomiting, and abdominal pain. The diagnosis is usually made from an upper barium study or computed tomography. Typically, SMA syndrome is caused by a decreased aortomesenteric angle of 6degrees to 25degrees. An underweight body mass index (BMI) is a risk factor for development of SMA syndrome. There are few reports of the role of linear endoscopic ultrasound (EUS) in the diagnosis of SMA syndrome. We report a case of SMA syndrome, with normal BMI, that was diagnosed with the aid of linear EUS. Although SMA syndrome is not typically within the scope of practice of endosonographers, it is useful to get familiar with the findings.

Keyword

Linear endosonography; Superior mesenteric artery syndrome; Body mass index

MeSH Terms

Abdominal Pain
Barium
Body Mass Index
Duodenum
Humans
Mesenteric Artery, Superior
Nausea
Risk Factors
Superior Mesenteric Artery Syndrome
Thinness
Vomiting
Barium

Figure

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  Fig. 1 Radiologic findings. (A) X-ray reveals a large amount of food with distension of the stomach and mild gas accumulation in the small and large bowels. (B) Abdominal computed tomography shows a huge distended stomach and duodenum. The duodenal third portion is compressed between the superior mesenteric artery and aorta (arrow).

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  Fig. 2 Upper endoscopic findings. (A) A large quantity of food remains in the stomach. (B) Extrinsic compression of the third portion of the duodenum by a vertical pulsation.

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  Fig. 3 Linear endoscopic ultrasound (EUS) findings. (A) Linear EUS shows the superior mesenteric artery running almost parallel to the abdominal aorta with an aortomesenteric angle of 10°, confirming the diagnosis of superior mesenteric artery syndrome (with video). (B) Normal linear EUS finding with an aortomesenteric angle of 67°.

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