History: 37 yo female with chronic nausea and vomiting that is getting progressively worse.
Solution: SMA syndrome
Narrowing of the angle between the SMA and aorta can compress the third portion of the duodenum causing proximal dilatation and obstructive symptoms. Often seen in thin people who have rapidly lost weight. On barium examination, the findings are as in this case, marked dilatation of the first and second portions of the duodenum with a vertical bandlike defect in the transverse duodenum. Obstruction may be partially relieved with the patient prone and on their elbows.
Treatment starts with adequate nutrition, NG tube decompression, and positioning of the patient after eating (left lateral decubitus, prone, or knee-to-chest position). Enteral tube feeding passed distal to the obstruction can be an effective adjunct in treatment. Most patients will be effectively treated with these conservative measures, but if not, surgical intervention may be necessary.
Narrowing of the angle between the SMA and aorta can compress the third portion of the duodenum causing proximal dilatation and obstructive symptoms. Often seen in thin people who have rapidly lost weight. On barium examination, the findings are as in this case, marked dilatation of the first and second portions of the duodenum with a vertical bandlike defect in the transverse duodenum. Obstruction may be partially relieved with the patient prone and on their elbows.
Treatment starts with adequate nutrition, NG tube decompression, and positioning of the patient after eating (left lateral decubitus, prone, or knee-to-chest position). Enteral tube feeding passed distal to the obstruction can be an effective adjunct in treatment. Most patients will be effectively treated with these conservative measures, but if not, surgical intervention may be necessary.
Radiograph Images
