SHM Converge Scientific Abstract ePoster Gallery-Acute Superior Mesenteric Artery Syndrome: A Rare but Devastating Complication of Advanced Malignancy

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This case report describes a rare but serious cause of proximal intestinal obstruction: superior mesenteric artery (SMA) syndrome. The condition occurs when loss of the fat pad between the aorta and SMA narrows the angle between these vessels, compressing the third part of the duodenum and causing obstruction. Symptoms are often nonspecific, such as abdominal pain, nausea, and vomiting.<br /><br />The patient was a 71-year-old man with advanced metastatic non-small cell lung cancer, recurrent deep venous thrombosis on anticoagulation, and prostatomegaly. He was initially hospitalized for community-acquired pneumonia and failure to thrive, with more than 30 pounds of weight loss. His hospital course was complicated by respiratory deterioration requiring ICU care, intubation, PEG tube placement, and tracheostomy.<br /><br />On hospital day 29, he developed sudden abdominal pain and biliary drainage from the PEG tube. CT imaging of the abdomen and pelvis showed marked dilation of the stomach and proximal duodenum with an abrupt transition at the level of the SMA, consistent with SMA syndrome. Surgery was consulted, and the PEG was placed to gravity drainage. Because of his severe comorbidities and poor overall condition, he was not considered a surgical candidate. He later suffered cardiac arrest and died on hospital day 34.<br /><br />The report emphasizes that SMA syndrome can occur in severely cachectic or debilitated patients, including those with advanced malignancy and significant weight loss. It can lead to major complications such as infection, renal failure, and metabolic derangements, contributing to high morbidity and mortality. Initial management is usually conservative, including gastrointestinal decompression, correction of electrolytes, and nutritional support, while surgery is reserved for refractory cases.

Asset Subtitle

Joel Joseph

Meta Tag

Author List Joel Joseph, Luqman-Arafath Thazhatuveetil-Kunhahamed, Sumera Andleeb

Category Clinical Vignettes

Concept Superior Mesenteric Artery Syndrome

Concept Proximal Intestinal Obstruction

Concept Third Portion of Duodenum

Concept Duodenal Compression

Concept Weight Loss

Distinguished Non-Finalist

Presenter Organization Wake Forest School of Medicine

Presenting Author Joel Joseph

Track Adult

Keywords

superior mesenteric artery syndrome

proximal intestinal obstruction

duodenal compression

weight loss

cachexia

advanced malignancy

metastatic lung cancer

abdominal pain

PEG tube drainage

conservative management

Superior Mesenteric Artery Syndrome

Proximal Intestinal Obstruction

Third Portion of Duodenum

Duodenal Compression

Weight Loss