A Rare Cause of Postprandial Pain

​BY DHIMITRI A. NIKOLLA, DO; BRENDAN A. MICCIO; MELODY L. MILLIRON; & BRETT FOREHAND, MD, PHDA 49-year-old woman with a past medical history of chronic obstructive pulmonary disease presented to the emergency department with epigastric pain. She said the pain radiated to her chest and had been intermittent for six months, but it had been progressively worsening over the previous three weeks. Her pain was exacerbated by eating, and was associated with early satiety and nausea. She complained of a 30-pound weight loss over the preceding three months.Her vital signs included a blood pressure of 116/80 mm Hg, a heart rate of 96 bpm, a respiratory rate of 16 bpm, a temperature of 36.6°C, and an Spo2 of 99% on room air. A physical examination revealed mild epigastric tenderness without peritoneal signs. A complete blood count, comprehensive metabolic panel, lipase, and lactic acid were within normal limits. A CT scan with IV contrast of the abdomen and pelvis (see photos) diagnosed superior mesenteric artery syndrome, also known as Wilkie's syndrome, a presentation of a reduced aortomesenteric angle (≤25°) resulting in a partial or complete blockage of the third portion of the duodenum.CT of the abdomen and pelvis (axial view) revealing duodenal dilation (asterisk) proximal to its course between the superior mesenteric artery (red arrow) and the aorta (black arrow) with narrowing distally.CT of the abdomen and pelvis (sagittal view) revealing a narrowed aortomesenter...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research