Cast syndrome

Abstract

Cast syndrome, commonly known as superior mesenteric artery (SMA) syndrome is a rare cause of small bowel obstruction caused by compression of third part of duodenum from narrowing of the angle between superior mesenteric artery and abdominal aorta resulting in symptoms of duodenal outflow obstruction. A 46-year-old male presented with acute worsening of chronic abdominal pain, nausea and vomiting aggravated with eating. Computed tomography of abdomen and pelvis revealed the dilatation of gastric and proximal duodenum due to compression of third part of duodenum between superior mesenteric artery and aorta. Conservative management with total parental nutrition failed and patient underwent gastrojejunostomy with relief of his symptoms. Cast syndrome is a rare condition but should be kept in mind in patients with abdominal pain, vomiting, early satiety and weight loss. CT abdomen usually reveals the diagnosis but upper GI endoscopy helps to rule out other causes of duodenal obstruction and gastric dilatation.

Figure 1:

This axial section of CT abdomen and pelvis shows decrease in distance between abdominal aorta and superior mesenteric artery, measured at 3.1 mm.

Figure 2:

This sagittal section of CT abdomen and pelvis shows narrow angle between abdominal aorta and superior mesenteric artery.

Figure 3:

This axial section of CT abdomen and pelvis shows dilated second part of duodenum.

Figure 4:

This section of CT shows gastric dilatation.