GP57 Acute superior mesenteric artery syndrome – association with growth spurts

Aim Superior Mesenteric Artery Syndrome is rare manifestation of duodenal obstruction arising due to external compression between the superior mesenteric artery and the aorta. The classic presentation involves postprandial abdominal pain and anorexia with weight loss. We aim to present the case of a 10-year-old female with an atypical presentation of acute Superior Mesenteric Artery Syndrome. Method We report the comprehensive history highlighting pertinent positives and negatives, clinical examination and radiological investigations during our patient’s inpatient admission. Result Ten-year-old female, weighing 35.6 lbs and height of 153.2 cm equating to a body mass index of 15.1, with congenital adrenal hyperplasia and precocious puberty presented for elective admission for twenty-four-hour adrenal profile. On admission, patient reported worsening indigestion over past twelve months, epigastric pain and hiccups necessitating gastrointestinal consultation. Patient self-reported food to become ‘stuck in the middle of her chest’. There was no associated nausea or vomiting or any recent weight loss reported. Symptoms failed to improve on a three-week course of proton pump inhibitors. A prior urea breath was negative. The patient was scheduled for barium swallow and follow through which demonstrated hold-up of the contrast in the second part of the duodenum, with the duodenal flexure in the correct position and no evidence of malrotation. After discussion as multidisciplinary conference the patient was re-admitted for elective oesophagogastroduodenoscopy. The results of which demonstrated a tighter transition from the second to third segment of the duodenum, with no mucosal abnormalities, consistent with extraluminal compression. Computed tomography with intravenous contrast was ordered which revealed reduced aortomesenteric angle and distance; findings which established the diagnosis of Superior Mesenteric Artery Syndrome. Conclusion Most cases of Superior Mesenteric Artery Syndrome are presentations of chronic duodenal obstruction. Acute forms can occur in the face of trauma. Our patient is an interesting case, who continued to thrive with height and weight proportional, and was atraumatic. On review in outpatient facility recurrence of the epigastric pain was found to coincide with a recent growth spurt. A potential new association for exacerbation of asymptomatic chronic duodenal obstruction due to Superior Mesenteric Artery Syndrome.