Effective conservative management of superior mesenteric artery syndrome presenting with chronic vomiting and postprandial pain in a young adult female: a case report

Introduction and importance: Superior mesenteric artery (SMA) syndrome is a rare vascular compression disorder characterized by the compression of the third portion of the duodenum between the abdominal aorta and the SMA. It typically manifests with upper gastrointestinal obstruction symptoms. Timely diagnosis is crucial and relies on a high index of suspicion along with appropriate imaging techniques. Case presentation: A 28-year-old female presented with a 3-month history of progressive postprandial vomiting, early satiety, and epigastric pain. Her malnutrition and symptoms, including vomiting undigested food several hours after meals, prompted further investigation for possible extrinsic compression. A computed tomography (CT) scan revealed a significantly narrowed aortomesenteric angle (14°) and reduced aortomesenteric distance (4 mm), confirming compression of the third duodenal segment consistent with SMA syndrome. Initial management included dietary modifications (small, frequent, and low-fat meals) and a trial of prokinetic therapy (metoclopramide), which provided partial symptomatic relief. Clinical discussion: This case underscores the importance of considering SMA syndrome in patients with chronic postprandial gastrointestinal symptoms, particularly in those exhibiting signs of malnutrition. Dedicated imaging, such as CT or magnetic resonance angiography, should be pursued when endoscopic evaluations yield non-obstructive findings but symptoms persist. Conclusion: Early diagnosis of SMA syndrome is essential for effective management, which may range from conservative nutritional strategies to surgical interventions. Clinicians should maintain a high level of suspicion for this condition in appropriate clinical contexts.