Intermittent superior mesenteric artery syndrome in a patient with multiple sclerosis

A 42-year-old man with multiple sclerosis presented with recurrent vomiting, in the context of recent weight loss. Computed tomography scan of the abdomen and pelvis revealed duodenal compression by the superior mesenteric artery (SMA), consistent with intermittent SMA syndrome. Subsequent gastroscopy and barium meal follow-through showed resolution of the obstruction. SMA syndrome is rare and has not previously been reported in a patient with multiple sclerosis. We hypothesize that loss of the aortomesenteric fat pad on the background of contorted body habitus from multiple sclerosis placed the patient at risk for intermittent positional compression of his duodenum.