A Case of Superior Mesenteric Artery Syndrome Caused by Anorexia Nervosa

Cheon Woo Lee; Moo In Park; Seun Ja Park; Won Moon; Hyung Hun Kim; Bong Joon Kim; In Kyoung Shim; Si Sung Park

doi:10.4166/kjg.2011.58.5.280

Journal List > Korean J Gastroenterol > v.58(5) > 1006879

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Lee, Park, Park, Moon, Kim, Kim, Shim, and Park: A Case of Superior Mesenteric Artery Syndrome Caused by Anorexia Nervosa

Case Report

Korean J Gastroenterol 2011;58(5):280-283.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.58.5.280

A Case of Superior Mesenteric Artery Syndrome Caused by Anorexia Nervosa

Cheon Woo Lee, Moo In Park, Seun Ja Park, Won Moon, Hyung Hun Kim, Bong Joon Kim, In Kyoung Shim, Si Sung Park¹

Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea

¹Department of Neuropsychiatry, Kosin University College of Medicine, Busan, Korea

Correspondence to: Moo In Park, Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, 34, Amnam-dong, Seo-gu, Busan 602-030, Korea. Tel: +82-51-990-6179, Fax: +82-51-990-6633, E-mail: mipark@kosinmed.or.kr

Received 21 December 2010 Accepted 23 March 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by compression of the third segment of the duodenum by the mesenteric artery at the level of the SMA, resulting in duodenal dilatation. Precipitating factors of the SMA syndrome include prolonged bed rest, weight loss, abdominal surgery, and increased lordosis of the spine. We report a case of SMA syndrome caused by anorexia nervosa in a 15-year-old adolescent girl. CT and an upper gastrointestinal contrast series revealed partial obstruction of the third portion of duodenum and decreased aortomesenteric distance. The patient's symptoms were successfully treated with total parental nutrition and psychiatric treatment including supportive, cognitive behavioral therapy and antidepressant medication. This case shows that SMA syndrome is an unusual gastrointestinal complication that may occur in patients with anorexia nervosa.

Keywords: Superior mesenteric artery syndrome, Anorexia nervosa

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Fig. 1.

Endoscopic findings. (A) Partial obstruction of the third portion of duodenum was observed. (B) Bile lake was observed in the stomach.

Fig. 2.

Upper gastrointestinal contrast study findings. (A) It showed dilatation of the second portion of duodenum and blocked barium passage with a cut-off sign in the third portion of the duodenum. (B) It showed the improved passage after position change from supine to knee-chest position.

Fig. 3.

Abdominal CT finding. It showed dilatation of the second portion of duodenum, and a compression of the third portion of duodenum between the aorta and superior mesenteric artery (arrow indicates the aortomesenteric distance, 0.74 mm).

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