{"pk":7466,"title":"An Uncommon Case of Abdominal Pain: Superior Mesenteric Artery Syndrome","subtitle":null,"abstract":"Superior mesenteric artery (SMA) syndrome is a rare cause of abdominal pain, nausea and vomiting that may be undiagnosed in patients presenting to the emergency department (ED). We report a 54-year-old male presenting to a community ED with abdominal pain and the subsequent radiographic findings.The patient’s computed tomgraphy (CT) of the abdomen and pelvis demonstrates many of the hallmark findings consistent with SMA syndrome, including; compression of the duodenum between the abdominal aorta and superior mesenteric artery resulting in intestinal obstruction, dilation of the left renal vein, and gastric distension. Patients diagnosed with SMA syndrome have a characteristically short distance between the superior mesenteric artery and the aorta (usually 2–8 mm) in contrast to healthy patients (10–34 mm). Our patient’s aortomesenteric distance was measured to be approximately 4 mm. Furthermore, the measured angle between the superior mesenteric artery and the aorta is reduced in patients withSMA syndrome from a normal range of 28°–65° to a measurement between 6°–22°. Our patient’s aortomesenteric angle was difficult to measure secondary to poor sagittal reconstructions, but appears to be approximately 30°. Following radiographic evidence suggesting SMA syndrome together with our patient’s constellation of presenting symptoms, a diagnosis of SMA syndrome was made and the patient was admitted to the general surgery service. However, our patient decided to leave against medical advice owing to improvement of his symptoms following the emptying of two liters of gastric contents via nasogastric tube evacuation. [West J Emerg Med. 2012;13(6):501-502]","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial  4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc/4.0"},"keywords":[{"word":"superior mesenteric artery syndrome"},{"word":"Emergency Medicine"}],"section":"Diagnostic Acumen","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8dv821bv","frozenauthors":[{"first_name":"Brent","middle_name":"Michael","last_name":"Felton","name_suffix":"","institution":"DO\nMichigan State University, Department of Emergency Medicine, Lansing, Michigan","department":"None"},{"first_name":"Josh","middle_name":"Michael","last_name":"White","name_suffix":"","institution":"MD\nMichigan State University, Department of Emergency Medicine, Lansing, Michigan","department":"None"},{"first_name":"Michael","middle_name":"Allen","last_name":"Racine","name_suffix":"","institution":"MD\nMichigan State University, Department of Emergency Medicine, Lansing, Michigan","department":"None"}],"date_submitted":"2012-06-05T17:47:30Z","date_accepted":"2012-06-05T17:47:30Z","date_published":"2012-11-14T23:22:59Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/7466/galley/4413/download/"}]}