Superior mesenteric artery syndrome after severe head trauma

Abstract

Superior mesenteric artery syndrome (SMAS) is a very rare manifestation of duodenal obstruction with the incidence of 0.013–0.3% in adult population, but there are only few reports in the literature concerning children. SMAS can be related to a rapid loss of intraabdominal fat by severe, debilitating illnesses such as malignancy, burn, spinal cord injury, anorexia. As a result, compression of the third duodenal portion by the aorta and the overlying superior mesenteric artery occurs, when the angle formed by these two structures becomes smaller. We present a case of a 17-year-old boy who suffered a severe head trauma during a car accident. He had prolonged confinement in the supine position because of ongoing coma. The SMAS developed due to a progressive weight lost. Upper gastrointestinal Barium contrast study, fibroesophagogastroduodenoscopy (FEGDS), abdomen computed tomography scan (CT) were not specific and only, magnetic resonance imaging (MRI) findings suggested diagnosis of SMAS. As there was no response to the conservative treatment, surgical intervention of duodenojejunostomy was performed. The postoperative period was successful. Keywords: Superior mesenteric artery syndrome, Duodenum obstruction, Severe head trauma, Weight loss, Surgical treatment