Deadly Aspiration Pneumonia Secondary to Superior Mesenteric Artery Syndrome

Superior mesenteric artery syndrome (SMAS) is a rare and unusual disease, suspected clinically and confirmed radiologically. It represents a duodenal obstruction secondary to the impingement of the third portion of the duodenum between the abdominal aorta (AA) and the superior mesenteric artery (SMA) due to decreased intraabdominal fat. High morbidity and mortality rates are linked to missed or late diagnosis that can lead to complications, such as gastric perforation and gastric hemorrhage. We present the case of a 33-year-old man who was not previously known to have a SMAS, who presented to the emergency department with signs of septic shock, complaining of fever and respiratory symptoms for several days. Investigations showed aspiration pneumonia secondary to an upper gastrointestinal obstruction with signs of SMAS on a computed tomography (CT) scanner. Acute and rapid deterioration led to cardiac arrest and death. Through this article, we highlight the importance of early and correct diagnosis of SMAS which can sometimes be challenging, since no number is strictly diagnostic and radiological images must be interpreted in light of the clinical history and physical examination.