An uncommon cause of duodenal obstruction in the elderly: atypical superior mesenteric artery syndrome
Location
Suwanee, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction
Superior mesenteric artery (SMA) syndrome is a rare cause of proximal small bowel obstruction resulting from extrinsic compression of the third portion of the duodenum between the abdominal aorta and the superior mesenteric artery, often due to a narrowed aortomesenteric angle. Classic risk factors include significant weight loss, recent spinal surgery, prolonged immobilization, or conditions leading to a diminished mesenteric fat pad. However, atypical presentations in patients without these traditional predisposing factors are uncommon and may delay diagnosis. This case report highlights an elderly male with SMA syndrome in the absence of typical risk factors, emphasizing the importance of maintaining a broad differential when evaluating older adults with nonspecific gastrointestinal symptoms.
Methods
We present a clinical case of an 80-year-old male who was evaluated for progressive nausea, early satiety, and unintentional weight loss over several weeks. A comprehensive clinical assessment was performed, including detailed history, physical examination, laboratory investigations, and advanced imaging. Upper gastrointestinal series and computed tomography (CT) with angiographic protocol were used to assess duodenal anatomy and the relationship between the aorta and SMA. The diagnostic criteria for SMA syndrome were based on imaging findings—specifically evidence of duodenal compression and a reduced aortomesenteric angle—and exclusion of alternate causes of obstruction. Management strategies were individualized based on the severity of symptoms and nutritional status.
Results
The patient’s presenting symptoms included progressive nausea, diminished oral intake, and significant unintended weight loss without antecedent triggers such as recent surgery, trauma, or documented rapid weight loss from another etiology. Physical examination revealed mild epigastric tenderness without peritoneal signs. Laboratory studies were unremarkable aside from evidence of mild dehydration. CT imaging revealed a markedly reduced aortomesenteric angle consistent with SMA syndrome and dilation of the proximal duodenum and stomach proximally, confirming the diagnosis. Conservative management, including nutritional support, gastric decompression, and positional therapy, was initiated. Over the course of hospitalization, the patient demonstrated gradual improvement of symptoms with increased tolerance of oral intake and stabilization of weight. No surgical intervention was required.
Discussion
This case illustrates an atypical presentation of SMA syndrome in an elderly patient lacking classic risk factors, such as recent spinal correction, severe cachexia, or rapid postoperative weight loss. While SMA syndrome predominantly affects younger individuals or those with significant changes in mesenteric fat, this case underscores that elderly patients may also develop this rare condition due to subtle anatomical or physiological changes associated with aging. Early recognition is essential because delayed diagnosis can lead to prolonged malnutrition, persistent symptoms, and increased morbidity. Imaging modalities such as CT with vascular reconstruction are critical for diagnosis by demonstrating duodenal compression and measuring the aortomesenteric angle, typically considered diagnostic when reduced below reference thresholds. Conservative management with nutritional rehabilitation remains the first line, and may be sufficient in many cases; surgical options, such as duodenojejunostomy, are reserved for refractory symptoms or complications. The rarity of atypical SMA presentations highlights the need for heightened clinical suspicion, particularly in patients with unexplained gastrointestinal complaints and weight loss irrespective of traditional risk profiles.
Embargo Period
5-15-2026
An uncommon cause of duodenal obstruction in the elderly: atypical superior mesenteric artery syndrome
Suwanee, GA
Introduction
Superior mesenteric artery (SMA) syndrome is a rare cause of proximal small bowel obstruction resulting from extrinsic compression of the third portion of the duodenum between the abdominal aorta and the superior mesenteric artery, often due to a narrowed aortomesenteric angle. Classic risk factors include significant weight loss, recent spinal surgery, prolonged immobilization, or conditions leading to a diminished mesenteric fat pad. However, atypical presentations in patients without these traditional predisposing factors are uncommon and may delay diagnosis. This case report highlights an elderly male with SMA syndrome in the absence of typical risk factors, emphasizing the importance of maintaining a broad differential when evaluating older adults with nonspecific gastrointestinal symptoms.
Methods
We present a clinical case of an 80-year-old male who was evaluated for progressive nausea, early satiety, and unintentional weight loss over several weeks. A comprehensive clinical assessment was performed, including detailed history, physical examination, laboratory investigations, and advanced imaging. Upper gastrointestinal series and computed tomography (CT) with angiographic protocol were used to assess duodenal anatomy and the relationship between the aorta and SMA. The diagnostic criteria for SMA syndrome were based on imaging findings—specifically evidence of duodenal compression and a reduced aortomesenteric angle—and exclusion of alternate causes of obstruction. Management strategies were individualized based on the severity of symptoms and nutritional status.
Results
The patient’s presenting symptoms included progressive nausea, diminished oral intake, and significant unintended weight loss without antecedent triggers such as recent surgery, trauma, or documented rapid weight loss from another etiology. Physical examination revealed mild epigastric tenderness without peritoneal signs. Laboratory studies were unremarkable aside from evidence of mild dehydration. CT imaging revealed a markedly reduced aortomesenteric angle consistent with SMA syndrome and dilation of the proximal duodenum and stomach proximally, confirming the diagnosis. Conservative management, including nutritional support, gastric decompression, and positional therapy, was initiated. Over the course of hospitalization, the patient demonstrated gradual improvement of symptoms with increased tolerance of oral intake and stabilization of weight. No surgical intervention was required.
Discussion
This case illustrates an atypical presentation of SMA syndrome in an elderly patient lacking classic risk factors, such as recent spinal correction, severe cachexia, or rapid postoperative weight loss. While SMA syndrome predominantly affects younger individuals or those with significant changes in mesenteric fat, this case underscores that elderly patients may also develop this rare condition due to subtle anatomical or physiological changes associated with aging. Early recognition is essential because delayed diagnosis can lead to prolonged malnutrition, persistent symptoms, and increased morbidity. Imaging modalities such as CT with vascular reconstruction are critical for diagnosis by demonstrating duodenal compression and measuring the aortomesenteric angle, typically considered diagnostic when reduced below reference thresholds. Conservative management with nutritional rehabilitation remains the first line, and may be sufficient in many cases; surgical options, such as duodenojejunostomy, are reserved for refractory symptoms or complications. The rarity of atypical SMA presentations highlights the need for heightened clinical suspicion, particularly in patients with unexplained gastrointestinal complaints and weight loss irrespective of traditional risk profiles.