Surgical management of superior mesenteric artery syndrome in a 16-year-old female: a case report and literature review

Introduction: Superior mesenteric artery syndrome (SMAS) is a rare gastrointestinal disorder caused by the compression of the third part of the duodenum between the superior mesenteric artery and the aorta. It typically presents with nonspecific upper gastrointestinal (GI) obstructive symptoms, making diagnosis challenging. This case report illustrates a classic presentation, diagnostic workup, and successful management of SMAS while highlighting a common comorbidity. Case presentation: A 16-year-old Arab female presented with symptoms of upper GI obstruction. Upper endoscopy revealed extrinsic duodenal compression. An abdominal computed tomography scan confirmed the diagnosis, showing a reduced aortomesenteric angle (12–28°) and distance (6–7 mm). Concurrent compression of the left renal vein (nutcracker syndrome) was also identified. After failed conservative management, the patient successfully underwent a duodenojejunostomy, which was converted to an open approach. Postoperatively, she experienced complete resolution of symptoms and significant weight gain. Clinical discussion: This case aligns with the typical demographic of SMAS, affecting young, slender females. Diagnosis relies on a high index of suspicion and radiological confirmation of a narrowed aortomesenteric angle and distance. The management follows a stepwise approach, beginning with conservative measures. Surgical intervention, specifically duodenojejunostomy, is highly effective when conservative therapy fails. The coexistence of nutcracker syndrome in this patient underscores the importance of a comprehensive radiological assessment to identify associated vascular compression syndromes. Conclusion: This report reinforces the importance of precise radiological criteria for diagnosing SMAS and adheres to the standard treatment algorithm. Surgical bypass via duodenojejunostomy resulted in an excellent outcome. Clinicians should maintain a high index of suspicion for SMAS in young patients with chronic upper GI symptoms and be aware of potential associated conditions, like nutcracker syndrome.