Food Insecurity Leading to Superior Mesenteric Artery Syndrome Managed Successfully with Endoscopic Gastrojejunostomy Stent

Patient: Female, 33-year-old Final Diagnosis: Superior mesenteric artery syndrome Symptoms: Intermittent right upper quadrant abdominal pain • bloating • nausea • nonvolitional postprandial bilious vomiting Clinical Procedure: Endoscopic gastrojejunostomy stent Specialty: Gastroenterology and Hepatology • General and Internal Medicine • Nutrition and Dietetics OBJECTIVE: Rare disease BACKGROUND: Food insecurity describes the lack of adequate and reliable access to food due to insufficient resources. The condition affects over one-quarter of the world’s population and is exacerbated by factors such as conflicts, climate variability, rising costs of nutritious food, and economic slumps; these challenges are amplified by poverty and inequality. Food insecurity is associated with many negative health outcomes, such as iron deficiency anemia, poor oral health, and stunting of growth in children. CASE REPORT: We present the case of a patient who had significant weight loss related to food insecurity then developed a rare adverse health outcome: superior mesenteric artery (SMA) syndrome. SMA syndrome is a condition in which reduction in the angle formed by the proximal SMA and aorta, most commonly from decreased mesenteric fat in the setting of significant weight loss, leads to compression of the third portion of the duodenum and resulting bowel obstruction. The patient underwent successful treatment with a novel approach: endoscopic placement of a gastrojejunostomy stent. CONCLUSIONS: Food insecurity remains a wide-ranging public health issue that can have direct impact on the clinical outcomes of individuals. We describe SMA syndrome as a rare adverse outcome in a food insecure individual, adding to the growing list of health consequences associated with this condition. We also highlight endoscopic placement of a gastrojejunostomy stent as an emerging alternative to surgical treatment of SMA syndrome. The success of the procedure in this patient adds to the body of evidence supporting its efficacy and safety profile for this population.