Gastric Ischemia Due to Superior Mesenteric Artery Syndrome in Anorexia Nervosa: A Case Report

Abstract Superior mesenteric artery (SMA) syndrome is a rare condition caused by the compression of the third portion of the duodenum between the aorta and the SMA. One of its associations is with weight loss conditions, such as anorexia nervosa (AN). Its incidence is unclear. Gastric ischemia due to acute gastric dilation is a rare but potentially fatal consequence of SMA syndrome. A 26-years-old female patient presented in the emergency department with a history of 3 days of abdominal pain and vomitting. Computed tomography (CT) scan exhibited esophageal, gastric and duodenal dilation due to an acute aorto-mesenteric angle, as well as evidence of diffuse free air suggesting perforation. She underwent an emergent laparotomy where a total gastrectomy with Roux-en-Y anastomosis was performed. The association between SMA and AN is underrecognized and should be taken into account. Even though gastric ischemia is very uncommon, it may be a fatal consequence and this case report is a good demonstration.