Superior mesenteric artery syndrome with vascular calcification in a maintenance hemodialysis patient

Superior mesenteric artery (SMA) syndrome is defined as trapping of the third portion of the duodenum between the SMA and the aorta. In this case, vascular calcification associated with dialysis might have contributed to the onset of SMA syndrome.

The patient was a 74-year-old woman who had been receiving maintenance hemodialysis. She developed sudden onset of severe recurrent vomiting during admission for pseudo-gout. CT of the abdomen revealed duodenal obstruction with an abrupt cutoff in the third portion of the duodenum, and dilatation of the first and second portions of the duodenum. The aortomesenteric angle was significantly sharp. In addition, severe vascular calcification was revealed in the SMA and aorta. The initial treatment was decompression of the obstruction by a nasogastric tube and parenteral nutrition for the management of fluid and electrolyte imbalance. She recovered with only conservative treatment.

Vascular calcification of the SMA and aorta might have contributed to compression of the third portion of the duodenum. Vascular calcification associated with dialysis could be a factor in SMA syndrome.