A 26-year-old woman with recent intentional weight loss presents with postprandial epigastric pain, bilious vomiting, and relief when she assumes the knee-chest position. CT shows compression of the third part of the duodenum between the aorta and superior mesenteric artery with a narrowed aortomesenteric angle. After nasogastric decompression, what is the most appropriate initial management?

• A Immediate duodenojejunostomy
• B Gastrojejunostomy with truncal vagotomy
• C Strongyloides serology and empirical anthelminthic therapy
• D Nutritional support with weight restoration, small frequent meals, and postprandial left lateral positioning ✓

Explanation

Superior mesenteric artery syndrome results from loss of the mesenteric fat pad after rapid weight loss, narrowing the aortomesenteric angle and compressing the third part of the duodenum. Most cases respond to conservative treatment: gastric decompression, correction of electrolytes, enteral or parenteral nutrition, and weight regain, which restores the fat pad. Surgery such as duodenojejunostomy is reserved for refractory cases.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.