Superior Mesenteric Artery Syndrome with Anorexia Nervosa: A Rare Case of Postprandial Vomiting in an Adolescent
Superior Mesenteric Artery Syndrome with Anorexia Nervosa: A Rare Case of Postprandial Vomiting in an Adolescent
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Background: Superior mesenteric artery (SMA) syndrome is an underdiagnosed complication of acute, severe weight loss, usually seen among adolescents.Reduction of mesenteric fat causes SMA to compress the duodenum against the abdominal aorta.It is a known complication of restrictive eating disorder like anorexia nervosa (AN).
Clinical Description: An 11-years-8-month-old girl presented with vomiting after feeds, and avoidance of food over 1.5 years, with weight loss, fatigue, and excessive sleepiness over the past 5 months.She attained menarche 10 here months ago, preceded by an apparent spurt in height, but developed amenorrhea following two cycles.
On examination, she was tall, relative to her weight with a low body mass index (BMI) of 12.3 kg/m2, Tanner stage 3.She showed exaggerated orthostatic pulse and blood pressure changes.
Her general physical and systemic examinations were otherwise normal.Management and Outcome: Routine blood investigations were unremarkable.Abdominal X-ray and barium swallow were normal.
Investigations for common chronic infections were negative, and she fulfilled the criteria for AN binge-purge type.Further, ultrasound abdomen showed reduction in the aortomesenteric distance and upstream dilation of the second and third part of sophie allport zebra the duodenum, suggestive of SMA syndrome, confirmed by computed tomography abdomen.Nutritional rehabilitation was done initially via nasogastric tube, later through nasojejunostomy, with high-calorie diet, gradually being shifted to oral.
With multidisciplinary team management, the child recovered, with weight gain of 2.67 kg over 3 weeks.Conclusion: Pediatricians need to keep in mind SMA syndrome as a rare cause of intractable vomiting and food aversion, especially during growth spurt with drastic fall in BMI due to eating disorders.
Nutritional rehabilitation and counseling are enough to reverse all symptoms.