S3760 More Than Just Nausea: A Multifaceted GI Case Revealing SMA Syndrome as the Culprit

Introduction: Superior mesenteric artery (SMA) syndrome is a rare condition that is characterized by duodenal compression (third part) by the aorta and the superior mesenteric artery, thus leading to symptoms which include: postprandial abdominal pain, nausea and vomiting, and weight loss. Etiology is multifaceted, which includes abnormal anatomy, rapid weight loss, and previous abdominal surgery. Epidemiologically, it is significant to note that young adult females are typically affected by this condition. A review paper found the median age to be 23 years old, with a range of 0-91 years being potentially affected as well. Overall, the incidence of this condition is 0.013%-0.78% based on radiographic studies. Case Description/Methods: A 32-year-old woman with SMA syndrome, substance dependencies, depression, gastritis, and focal nodular hyperplasia presented with severe, generalized abdominal pain, nausea, and vomiting, symptoms recurrent over the past 4-5 months. Lab tests showed abnormal bicarbonate, glucose, aspartate aminotransferase, lactate, and phosphorus levels. A GI consult linked her symptoms to significant weight loss from the medication Mounjaro, suggesting potential exacerbation of SMA syndrome. The patient's condition persisted, prompting recommendations for Computed tomography (CT) Angiography and further endoscopic evaluation to explore underlying causes, including potential vascular issues related to SMA syndrome. Earlier imaging of CT Angiography revealed no significant change of the 6 cm mass between the liver and the duodenum, and that there was a decreased aortomesenteric angle which supports the diagnosis of SMA syndrome. Discussion: SMA syndrome is a significant contributor to morbidity and mortality, particularly when associated with large bowel obstructions and weight loss. Diagnostic workups typically include imaging, with an Upper Gastrointestinal Contrast Study being optimal for diagnosis. This study assesses 5 key criteria: duodenal dilation, abrupt compression of the duodenum's third part, “To-and-fro” contrast flow before the compression point, delayed contrast passage to the jejunum, and relief of compression by the Hayes maneuver. A definitive diagnosis may require surgical exploration. Treatment primarily involves conservative methods like fluid resuscitation, total parenteral nutrition, nasogastric tube placement for enteral feeding, and dietary adjustments. If these interventions fail, surgical management may be necessary.