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Superior mesenteric artery syndrome

Case contributed by Hani Makky Al Salam
Diagnosis almost certain

Presentation

Young patient with history of progressive weight loss, recurrent vomiting, and postprandial epigastric pain.

Frontal abdominal radiograph demonstrating paucity of small and large bowel gas with probable double bubble sign indicating proximal bowel obstruction.

Distended stomach, first and second part of duodenum with only small amount of contrast passed through the rest of the duodenum and proximal jejunum suggestive of obstruction at level of second part of duodenum.

CT scan of the abdomen shows hugely distended stomach, first and second part of the duodenum, with transition zone at the origin of the SMA, confirming the diagnosis of SMA syndrome.

Case Discussion

Superior mesenteric artery syndrome. Note the double bubble sign on plain x-rays.

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