P0955 - Superior Mesenteric Artery Syndrome in a Patient With Latent Autoimmune Diabetes of Adulthood: A Case Report

Ans Albustamy, MD¹, Mohammed Shakhatreh, MD¹, Grigoriy Rapoport, MD², Nghia Nguyen, DO, MS¹, Asif Zamir, MD, FACG^1
1University of Texas Rio Grande Valley at Doctors Hospital at Renaissance, Edinburg, TX; ²University of Texas Rio Grande Valley at Doctor's Hospital at Renaissance, Edinburg, TX

Introduction: Superior mesenteric artery (SMA) syndrome is a rare cause of proximal small bowel compression by the abdominal aorta and superior mesenteric artery causing symptoms consistent with small bowel obstruction. SMA syndrome is linked to notable morbidity and mortality when the diagnosis is delayed. SMA syndrome is associated with significant and rapid weight loss conditions, like anorexia nervosa and malabsorptive diseases. We present a case of SMA syndrome in a patient with latent autoimmune diabetes of adulthood (LADA).

Case Description/Methods: A 35 year old woman presented for evaluation of a positive fecal occult blood test. She complained of postprandial epigastric pain that was non-radiating. In addition, she endorsed early satiety with nausea and a 70 lb. unintentional weight loss over the last year. Epigastralgia was noted on physical exam. Approximately 3 months prior she followed up with endocrinology and was found to have positive glutamic acid carboxylase (GAD) 65 antibodies and was diagnosed with LADA. She was scheduled for EGD and colonoscopy. EGD revealed antral gastritis, a small hiatal hernia, and a pulsatile, extrinsic compression of the 3^rd portion of the duodenum and a presumptive diagnosis of SMA syndrome was made. Colonoscopy was unremarkable. CT abdomen/pelvis w/ contrast revealed a compression of the third portion of duodenum by the aorta and SMA, consistent with SMA syndrome. With diabetes management, the patient gained weight with resolution of her symptoms. Subsequent upper GI series with small bowel follow-through revealed no obstruction to suggest SMA syndrome.

Discussion: This patient presented with recently diagnosed LADA and a 70 lb. weight loss. Clinical findings, endoscopic and cross-sectional imaging were consistent with SMA syndrome. Current literature points towards an association with hypermetabolic processes in which significant weight loss predisposes patients to developing SMA syndrome. In our patient, rapid weight-loss was a consequence of LADA, leading to the development of SMA syndrome with resolution of symptoms after weight gain with diabetes management. Therefore, we suggest to investigate and treat reversible causes of SMA syndrome prior to the consideration of surgery.



Disclosures:


Ans Albustamy, MD¹, Mohammed Shakhatreh, MD¹, Grigoriy Rapoport, MD², Nghia Nguyen, DO, MS¹, Asif Zamir, MD, FACG¹. P0955 - Superior Mesenteric Artery Syndrome in a Patient With Latent Autoimmune Diabetes of Adulthood: A Case Report, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.