SHM Converge Scientific Abstract ePoster Gallery-That Pancreas Is Smashed!

Pdf Summary

This case describes a 33-year-old woman with severe malnutrition from long-term food insecurity who developed superior mesenteric artery (SMA) syndrome complicated by acute pancreatitis. She had a history of ESRD on hemodialysis, hypertension, reflux, and seizures, and presented cachectic with a BMI of 13.45 kg/m², epigastric tenderness, abdominal pain, bloating, and bilious vomiting after eating.<br /><br />CT imaging showed marked gastric and proximal duodenal dilation with narrowing of the aortomesenteric angle to 16°, compressing the third portion of the duodenum—classic for SMA syndrome. Labs showed elevated lipase (1,030 U/L) and mild liver test abnormalities, consistent with pancreatitis. She was treated initially with bowel rest, IV fluids, symptom control, and nutritional support, but could not tolerate oral intake because of persistent obstruction symptoms.<br /><br />Further evaluation with EGD and EUS confirmed duodenal angulation/obstruction, and a gastrojejunostomy (GJ) stent was placed to bypass the obstruction. After this intervention, she was able to tolerate regular food and was discharged.<br /><br />The report emphasizes that SMA syndrome is rare and usually results from significant weight loss causing loss of mesenteric fat and narrowing of the angle between the SMA and aorta, leading to duodenal compression. Symptoms commonly include nausea, vomiting, epigastric pain, reflux, and weight loss, creating a vicious cycle of worsening malnutrition. Acute pancreatitis is an extremely uncommon complication and remains a diagnosis of exclusion. Treatment ranges from conservative measures and nutritional rehabilitation to TPN, GJ feeding/stenting, or definitive surgical bypass. The case highlights the need to consider SMA syndrome in severely underweight patients with persistent upper GI symptoms.

Asset Subtitle

Evan Raff

Meta Tag

Author List Elizabeth Cole, Evan Raff, Lauren Raff, Lindsey Phillips

Category Clinical Vignettes

Concept Superior Mesenteric Artery Syndrome

Concept Weight Loss

Concept Aortomesenteric Angle

Concept Food Insecurity

Concept Third Portion of Duodenum

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Evan Raff

Track Adult

Keywords

superior mesenteric artery syndrome

acute pancreatitis

severe malnutrition

duodenal obstruction

aortomesenteric angle

cachexia

gastrojejunostomy stent

bilious vomiting

hemodialysis

weight loss

Superior Mesenteric Artery Syndrome

Weight Loss

Aortomesenteric Angle

Food Insecurity

Third Portion of Duodenum