Diagnostic Pitfalls in Superior Mesenteric Artery Syndrome: A Case Report

Superior mesenteric artery (SMA) syndrome is an uncommon yet clinically important cause of upper intestinal obstruction, occurring when the third segment of the duodenum is compressed between the superior mesenteric artery and the abdominal aorta, typically due to loss of the mesenteric fat pad that narrows the aorto-mesenteric angle and decreases the distance, most commonly following substantial weight loss. We present the case of a 52-year-old woman who developed persistent vomiting, diarrhoea, abdominal pain, and significant unintentional weight loss. Initial blood tests, stool studies, and endoscopic evaluation did not reveal any abnormalities. However, contrast-enhanced CT of the abdomen revealed significant narrowing of the space between the aorta and the superior mesenteric artery, along with a decreased vascular angle consistent with the diagnosis of SMA syndrome. She was managed conservatively with nutritional support, dietary modification, and postural therapy, resulting in gradual symptomatic improvement. This case highlights the diagnostic challenge of SMA syndrome and the importance of considering it in patients with unexplained weight loss and gastrointestinal obstruction symptoms, particularly when endoscopy is normal. Early recognition and radiological confirmation are crucial to guide appropriate management. Conservative treatment remains first-line, with surgery reserved for refractory cases. Maintaining a high index of suspicion for SMA syndrome is essential when evaluating patients with unexplained weight loss and persistent gastrointestinal symptoms.