Cyclic vomiting in a young patient with superior mesenteric artery syndrome

Superior mesenteric artery syndrome (SMAS) is a rare condition characterized by duodenal compression through aorto-mesenteric clamp, also known as the Wilkie's syndrome. In SMAS passage is blocked in the lower part of the duodenum by vascular compression. Precipitating factors include increased lordoses, loss of abdominal muscle tone, rapid weight loss (2), abdominal surgery, or intrabdominal inflammatory conditions that may compress the mesenteric vessels. Symptoms are usually non specific and intermittent and include post- prandial epigastric fullness, bloating, nausea, vomiting, and abdominal pain that are usually relieved by the prone or knee-to-chest position (3). Diagnosis is based on im- aging techniques that include X-ray passage series of the upper gastrointestinal tract and angiographical visualiza- tion of the superior mesenteric artery and determination of its angle of branching from the aorta. Retrocolic duo- denojejunostomy has proven to be the most satisfactory surgical treatment for this lesion (4).