Superior mesenteric artery syndrome complicated with duodenal bulb–descending ulcerative stricture: a case report and literature review

Background: Duodenal stasis syndrome is a clinical condition characterized by impaired emptying of the proximal duodenum, arising from either functional motility disorders or mechanical obstruction. Superior mesenteric artery syndrome (SMAS) is the most recognized mechanical cause; however, its coexistence with ulcer-related duodenal strictures is rare and presents considerable diagnostic and therapeutic challenges. Case presentation: A 40-year-old man presented with recurrent postprandial epigastric distension and vomiting for more than 30 years. Endoscopy revealed complex ulcers with stenosis involving the duodenal bulb and descending segment, and CT angiography demonstrated markedly reduced aortomesenteric angle (AMA) and distance (AMD), consistent with SMAS. Given the failure of long-term conservative therapy, laparoscopic side-to-side gastrojejunostomy with Braun anastomosis was performed, resulting in complete symptom resolution and favorable weight recovery at one-year follow-up. Discussion: This case illustrates how SMAS and ulcer-induced strictures may create a dual-level obstruction forming a vicious cycle, and emphasizes the need for integrated evaluation using CT angiography and high-resolution endoscopy. Therapeutic strategies remain debated among conservative, endoscopic, and surgical approaches, whereas minimally invasive bypass surgery offers more durable outcomes in patients with fixed fibrotic strictures. Conclusion: Clinicians should maintain a high index of suspicion for SMAS and associated lesions in patients with long-standing upper gastrointestinal obstruction. Complementary assessment using CT angiography and endoscopy is essential for identifying complex obstructive mechanisms. In selected patients with combined vascular compression and fixed duodenal stenosis, laparoscopic bypass reconstruction may represent an effective therapeutic option, although further evidence from larger clinical series is required to confirm its long-term efficacy.