Acute abdominal pain caused by superior mesenteric artery syndrome in a healthy young boy

Description

A 19-year-old healthy Korean boy presented with severe abdominal pain during the flight from Korea to Japan. Before his flight, the patient had no abdominal pain or surgical history in the past. A knee-chest position could relieve the symptoms. Vital signs were normal except a slight elevation of body temperature. The patient was thin, with a BMI of 16.8 kg/m² (figure 1). Abdominal tenderness, distention, and guarding were observed. White cell count was 17.9x10³/µL with 81.9% neutrophil and C reactive protein was <0.2 mg/dL. Abdominal radiography revealed the dilated stomach (figure 2) and contrast-enhanced CT showed compression at the third part of the duodenum as well as left renal vein (figures 3 and 4), resulted in angulation and reduction in the distance between the aorta and the superior mesenteric artery (SMA), suggesting SMA syndrome. Nasogastric tube drainage yielded about 2000 mL of...

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