Superior Mesenteric Artery Syndrome Secondary to Anorexia Nervosa and Methamphetamine Use

Superior mesenteric artery (SMA) syndrome, or Wilkie syndrome, is a rare cause of small bowel obstruction due to compression of the duodenum between the SMA and aorta. Patients most at risk of SMA syndrome include those with rapid weight loss due to a variety of conditions including chronic illness, malignancy, trauma, HIV, eating disorders, substance abuse, or bariatric surgery. Characteristic radiologic findings include an aortomesenteric angle less than 25 degrees and an aortomesenteric distance of less than 8 mm. Symptoms are typically postprandial and notably include abdominal fullness, voluminous emesis, and abdominal pain. Here we present a case of SMA syndrome in a 19-year-old cachectic female who initially presented with sudden-onset nausea, vomiting, and severe abdominal pain. Imaging revealed a severely distend stomach and proximal duodenum with a transition point in the third portion of the duodenum consistent with SMA syndrome. Her symptoms resolved with nasogastric decompression in addition to fluid and electrolyte management. She later endorsed restrictive eating patterns consistent with anorexia nervosa as well as methamphetamine use for weight loss. She underwent close outpatient follow-up for her anorexia nervosa and substance abuse.