Usefulness of ultrasonography for diagnosis and treatment in case of superior mesenteric artery (SMA) syndrome

Abstract

A 37-year-old man, who had been admitted to another facility because of integration dysfunction syndrome suffered from postprandial epigastric pain, vomiting and weight loss. He was referred to our hospital for further examinations and treatment. Ultrasound examination revealed gastric and duodenal dilatation, reduction of the distance between the superior mesenteric artery (SMA) and aorta and to-and-fro movement in his duodenum, suggesting SMA syndrome. Computed tomography and upper gastrointestinal tract examination also showed findings typical of SMA syndrome. We measured the SMA-aorta distance and the passage of duodenal contents in various body positions using ultrasound. He had to-and-fro movements in his duodenum in a supine, sitting, and left recumbent position. However, when examined in the right recumbent position, the SMA-aorta distance became longest, and intestinal juice flowed from the duodenum to the jejunum. He underwent postural therapy, maintaing a right recumbent position for 30 minutes after every meal, which improved his clinical symptoms.