Recurrent abdominal pain: Unique case of SMA-like syndrome

Abstract

Superior mesenteric artery (SMA) syndrome is a rare condition in which the duodenum is compressed between the SMA and the aorta, causing gastrointestinal symptoms, however SMA-like syndrome is vascular compression by other arterial or venous mesenteric vessels. We present a unique case, nondescribed before, of SMA-like syndrome, involving superior and inferior mesenteric arteries (SMA and IMA). Case report: A 40-year-old man patient with medical history of type 1 diabetes, Crohn's disease (improved and stable), presented with postprandial pain, nausea and early satiety. After biological and imaging investigations, CT scan revealed unusual compression of the third portion of the duodenum between the superior and inferior mesenteric arteries. CT angiography provided vascular mapping and helped to rule out some differential diagnoses. The patient was managed conservatively with dietary modifications and prokinetic agents, which improved symptoms. Conclusion: SMA-like syndrome, although rare, should be considered in patients with similar symptoms. The involvement of both mesenteric arteries in duodenal compression is a unique presentation. The diagnosis confirmation is easy by CT angiography, and conservative treatment can be effective in such cases.