History:-
Patient presented inmedicine opd on 17/1/25 with
complaint of
1:- Anorexia for 2-3 months
2:- Undocumented Weight loss more pronounced
since 20 days( BMI 12.5kg/m2)
3:- Vomiting for 2 months (greenish yellow in colour
immediately after eating containing food particles)
3.
Clinical Examination:-
• GeneralPhysical Examination:-
• Emaciated look
• Pallor
• Conscious and oriented in time and space
• Pulse:- 120bpm
• Abdominal examination:-
• Soft and non tender
• no visceromegaly
• bowel sound audible
• Chest Examination:-
• Unremarkable
4.
• Ultrasound pelvisdone on 13/1/25 demonstrate free
fluid in cul-de-sac and cystitis
• while admitted in medical unit patient underwent
EGD on 22/1/25 with following findings
• Stomach is grossly dilated, distended bulb and
proximal part of descending duodenum
• Their was abrupt narrowing of lumen of descending
duodenum
• Ultrasound pelvis done on 13/1/25 demonstrate free
fluid in cul-de-sac and cystitis
5.
• CT scanabdomen done on 24/1/25 showed
following findings
• Dilated fluid filled stomach, D1 , D2 and proximal
D3 dilated with transition point at aortomesenteric
region between superior mesenteric artery and
abdominal aorta with decreased aortomesenteric
angle of 6.6 degree and aortomesenteric distance
in 5.1mm
6.
What is SMA:-
Superiormesenteric artery syndrome is gastro vascular disorder in
which the thirt and the final portion of duodenum is compressed
between the abdominal aorta and overlying superior mesenteric artery
Risk Factors
• Weight loss
• Spinal cord Injury
• Spinal cord surgery
• Clinial features
• Nausea Vomiting
• Post prandial epigastric pain
• Early satiety
• Weight loss
• Abdominal pain
7.
• Symptoms tobe relieved by lying prone left lateral
decubitus position
• Signs
• Succession splash
• High pitched bowel sounds
8.
• Conservative Management:-
•Weight gain/ nutritional build-up
• Decompression with NG tube
• Surgical Management:-
• Strong procedure
• Release Ligament of treitz
• Gastro-jejunostomy
• Duodeno-jejunostosmy
