P0414 - More Than Just Nausea: A Multifaceted GI Case Revealing SMA Syndrome as the Culprit

Rajmohan Rammohan, MD, Dilman Natt, MD, Sai Reshma Magam, MD, Achal Patel, MD, Leeza E. Pannikodu, MD, Sindhuja Giridharan, MD, Sri Harsha Boppana, MD, Venkata Panchagnula, MD, Amilcar Guaschino, MD, Cesar Orlando Ortiz Bernard, MD, Amina Zafar, MD, Krishnaiyer Subramani, MD, Paul Mustacchia, MD
Nassau University Medical Center, East Meadow, NY

Introduction:
SMA syndrome is a rare condition that is characterized by duodenal compression (3rd 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 female 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, AST, 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 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:
Superior Mesenteric Artery Syndrome (SMA Syndrome) is a significant contributor to morbidity and mortality, particularly when associated with large bowel obstructions and weight loss. Diagnostic work-ups typically include imaging, with an Upper Gastrointestinal Contrast Study being optimal for diagnosis. This study assesses five 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.



 





Figure: 1. CT Abdomen with IV Contrast Supporting SMA Diagnosis

Disclosures:
Rajmohan Rammohan indicated no relevant financial relationships.
Dilman Natt indicated no relevant financial relationships.
Sai Reshma Magam indicated no relevant financial relationships.
Achal Patel indicated no relevant financial relationships.
Leeza Pannikodu indicated no relevant financial relationships.
Sindhuja Giridharan indicated no relevant financial relationships.
Sri Harsha Boppana indicated no relevant financial relationships.
Venkata Panchagnula indicated no relevant financial relationships.
Amilcar Guaschino indicated no relevant financial relationships.
Cesar Orlando Ortiz Bernard indicated no relevant financial relationships.
Amina Zafar indicated no relevant financial relationships.
Krishnaiyer Subramani indicated no relevant financial relationships.
Paul Mustacchia indicated no relevant financial relationships.

Rajmohan Rammohan, MD, Dilman Natt, MD, Sai Reshma Magam, MD, Achal Patel, MD, Leeza E. Pannikodu, MD, Sindhuja Giridharan, MD, Sri Harsha Boppana, MD, Venkata Panchagnula, MD, Amilcar Guaschino, MD, Cesar Orlando Ortiz Bernard, MD, Amina Zafar, MD, Krishnaiyer Subramani, MD, Paul Mustacchia, MD. P0414 - More Than Just Nausea: A Multifaceted GI Case Revealing SMA Syndrome as the Culprit, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.