SUN-673 Superior Mesenteric Artery Syndrome: A Rare Adverse Effect of Rapid Weight Loss

Abstract Disclosure: B.A. Vista: None. O.C. Dampil: None. R.L. Dela Cruz: None. Background: Superior mesenteric artery (SMA) syndrome is a rare condition caused by duodenal compression between the aorta and the superior mesenteric artery, often resulting from the loss of mesenteric fat. Common triggers include rapid weight loss, malignancy, malabsorption, and other chronic conditions. Symptoms typically include postprandial epigastric pain, nausea and vomiting. Diagnosis is primarily radiologic, with CT imaging showing a reduced aortomesenteric angle (<22–28°) and distance (<8 mm).This case presents a Filipino patient with Type 2 Diabetes Mellitus and mixed anxiety and depressive disorder, diagnosed with SMA syndrome presenting as recurrent episodes of epigastric pain, nausea, and vomiting, following a significant weight loss of 10 kg over six months. Clinical Case: A 30-year-old female, with Type 2 Diabetes Mellitus and recently diagnosed with mixed anxiety and depressive disorder, presented with 1 month history of recurrent episodes of epigastric pain, nausea, vomiting, and significant weight loss of 10 kg over 6 months (42 kg from 52 kg). The patient reported that she was under considerable stress, which led to a poor appetite and a reduction in her food intake to only one meal per day. Physical examination revealed a BMI of 17 (Height 157 cm, weight 42 kg). Initial laboratory findings showed leukocytosis (WBC 13,150 mm3; Reference range 4800-10800), hypokalemia (K 3.1 mmol/L), normal renal function (Creatinine 0.66 mg/dL egFR 121), and normal lipase 22 U/L (Reference range 12-53 U/L). 12L ECG showed sinus rhythm, with nonspecific ST-T wave changes. Urinalysis was unremarkable and pregnancy test was negative. A whole abdominal CT scan with oral contrast revealed a reduced aorto-mesenteric angle, measuring 20.4°, with apparent compression of the left renal vein and the third portion of the duodenum. The patient was diagnosed with SMA syndrome. She was initially placed on NPO, received intravenous fluids, and underwent electrolyte replacement therapy. As her symptoms improved, she was gradually advanced to a clear liquid diet, followed by the introduction of oral medications and further dietary progression. At her 6-month follow-up, she achieved weight gain (54 kg from 42 kg, BMI 21.9) with resolution of symptoms and normalization of the aortomesenteric angle (34.2°). Conclusion: This case highlights the importance of recognizing SMA syndrome as a possible serious complication of rapid weight loss, particularly in patients presenting with gastrointestinal symptoms such as abdominal pain, nausea, and vomiting. The risk may be heightened in individuals with psychological conditions like mixed anxiety and depressive disorder, where significant weight loss may occur. Non-surgical intervention can be effective through early detection and prompt management. Presentation: Sunday, July 13, 2025