Duodenal compressions from non-superior mesentery artery structures in the same patient causing superior mesentery artery-like syndrome: a rare case report

Superior mesentery artery (SMA)-like syndrome is an increasingly used term to describe vascular compression of the third duodenal portion between structures other than the superior mesenteric artery and aorta. Although rare, this clinical condition is as serious as true SMA syndrome and requires similar management. However, the diagnostic criteria are not well established yet and require a case-by-case analysis, including a review of various clinical symptoms, especially evolving ones, as well as radiological imaging and effectiveness of conservative therapeutic manoeuvres. The presented case involves a double vascular compression in a 50-year-old woman with no medical history, one of which is between 2 venous structures. The patient had been experiencing recurrent abdominal pain, vomiting, and distension for a long time. Laboratory tests were normal, and gastroesophageal endoscopy revealed Barrett's oesophagus. CT-enterography revealed 2 duodenal vascular compressions. Dietary measures were initiated with close follow-up. To the best of our knowledge, this is the first reported case in the world literature and adds to the existing body of SMA-like syndromes.