Introduction and importance: Superior mesenteric artery (SMA) syndrome is a rare cause of proximal intestinal obstruction, typically associated with significant weight loss. Acute complete duodenal obstruction is an uncommon and severe presentation, particularly in adolescents. Case presentation: A 15-year-old severely underweight male presented with acute bilious vomiting and abdominal distension following months of early satiety and weight loss. Imaging demonstrated gastric and proximal duodenal dilatation. Computed tomography confirmed compression of the third portion of the duodenum with a reduced aortomesenteric angle. Despite 5 days of optimized conservative management, the patient showed no clinical improvement. Clinical discussion: Laparoscopic duodenojejunostomy was performed. The postoperative course was uneventful, with complete resolution of symptoms, restoration of oral intake, and significant weight gain. Conclusion: This case highlights a rare, severe presentation of SMA syndrome and underscores the importance of early recognition and timely surgical intervention when conservative management fails.
Alqahtani et al. (Mon,) studied this question.