Delayed diagnosis of vascular compression syndrome mimicking chronic gastritis: a case report

The superior mesenteric artery (SMA) syndrome is a rare condition where the third part of the duodenum is compressed between the abdominal aorta and the SMA. It often causes nonspecific upper abdominal symptoms that mimic common problems like gastritis, leading to delays in diagnosis.

A 23-year-old woman from central Nepal had 5 years of epigastric pain, nausea, occasional vomiting, acid brash, and gradual weight loss. She was repeatedly treated for gastritis without improvement. Initial ultrasound was normal, and endoscopy showed antral gastritis. Contrast-enhanced CT revealed a very narrow aorto-mesenteric angle (14°) and distance (3.6 mm), confirming SMA syndrome, along with the narrowing of the celiac trunk, thrombosis of the SMA, and signs of pelvic congestion. Conservative treatment failed, and she underwent open duodenojejunostomy. After surgery, her symptoms resolved completely, and she gradually gained weight.

This case shows that the SMA syndrome can be missed for years, especially when endoscopy shows only secondary gastritis. Early CT scanning and timely surgery can cure symptoms and prevent prolonged suffering.

The SMA syndrome should be considered in young patients with chronic upper abdominal pain, persistent vomiting, and unexplained weight loss. Prompt imaging and surgical management are often needed for lasting recovery.