Superior Mesenteric Artery Syndrome Following Tubercular Intestinal Perforation

Superior mesenteric artery (SMA) syndrome is a rare clinical entity characterized by the compression of third part of the duodenum between the superior mesenteric artery and abdominal aorta due to loss of intervening mesenteric fat pad. This article reports a case of a patient operated for tubercular intestinal perforation following which she developed postprandial abdominal pain and recurrent vomiting in the postoperative period. Contrast enhanced computed tomography (CECT) of abdomen was done which showed gastric dilatation extending till the third part of duodenum with decreased aorto-mesenteric angle, compatible with the diagnosis of SMA syndrome. The patient was managed conservatively on total parenteral nutrition. Six weeks after the surgery, patient's symptoms resolved completely on conservative management and recovered without any need of surgical intervention. This case illustrates the pathogenesis of SMA syndrome in the setting of severe weight loss caused by tuberculosis superimposed by the catabolic state of surgery leading to rapid loss of mesenteric fat which was successfully managed conservatively.