"WHEN HUNGER HURTS: A TIGHT ANGLE BENEATH THE PAIN— SUPERIOR MESENTERIC ARTERY SYNDROME IN AN ADOLESCENT AS A SURGICAL TURNING POINT" singhsaumya16@yahoo.com

 

"WHEN HUNGER HURTS: A TIGHT ANGLE BENEATH THE PAIN— SUPERIOR MESENTERIC ARTERY SYNDROME IN AN ADOLESCENT AS A SURGICAL TURNING POINT"

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India

Poster with Discussion

Superior Mesenteric Artery (SMA) syndrome is a rare cause of proximal intestinal obstruction due to compression of the third portion of the duodenum between the SMA and aorta. The condition is often underdiagnosed due to nonspecific symptoms and requires a high index of suspicion, especially in individuals with significant weight loss.

Case presentation: We present a 14-year-old male with a six-month history of postprandial abdominal pain and severe sitophobia, resulting in profound malnutrition (BMI 12.5 kg/m²). Initial laboratory investigations were noncontributory. Contrast-enhanced CT revealed a narrowed aortomesenteric angle (10.8°) and distance (8.0 mm), with duodenal compression and dilatation. Intraoperative findings included duodenal kinking due to adhesive bands in addition to the vascular compression. The patient underwent a modified Strong’s procedure with meticulous adhesiolysis, which completely relieved the obstruction.

Outcome: Postoperatively, the patient experienced rapid resolution of pain and regained appetite within one week, with complete recovery and resumption of normal feeding.

This case underscores the importance of early imaging and anatomical assessment in patients with chronic postprandial pain and weight loss. SMA syndrome, though rare, should be actively considered in malnourished adolescents. While conservative treatment is often attempted, this case highlights that tailored surgical intervention—guided by intraoperative findings—can offer definitive, curative outcomes. A Strong’s procedure with duodenal mobilization and adhesiolysis remains an effective, physiologically sound alternative to bypass surgery in select cases.