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Case Reports
. 2021 Feb 23;14(2):e237132.
doi: 10.1136/bcr-2020-237132.

Superior mesenteric artery syndrome in a patient with celiacomesenteric trunk

Swanit Hemant Deshpande  1 , Jenny Thomas  1 , Roshan Chiranjeev  1 , Jayashri Sanjay Pandya  2
Affiliations
Case Reports

Superior mesenteric artery syndrome in a patient with celiacomesenteric trunk

Swanit Hemant Deshpande et al. BMJ Case Rep. .

Abstract

Superior mesenteric artery (SMA) syndrome is an uncommon entity leading to compression of the duodenum between the aorta and the SMA. Normally the coeliac trunk and the superior mesenteric arteries have distinct origins from the abdominal aorta. The celiacomesenteric trunk (CMT) is the least frequently reported anatomic variation of all abdominal vascular anomalies. CMT denotes a common trunk of origin of the coeliac and superior mesenteric arteries. The coexistence of these anomalies has never been reported in the literature. We present a case of a 59-year-old man presenting with duodenal obstruction due to SMA syndrome with CMT. The aortomesenteric angle was 13 degrees and SMA-aorta distance was 8 mm. Patient underwent a gastrojejunostomy. After an uneventful recovery, the patient has been symptom free for 1-year follow-up.

Keywords: gastroenterology; radiology; surgery.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(Left half)- vascular reconstruction image of the CECT scan depicting the various branches of the celiaco-mesenteric trunk. (Right half)- pictorial depiction of Type I’ of Morita classification (16). AA, abdominal aorta; Ca, coeliac artery; CECT, contrast-enhanced CT; CHA, common hepatic artery; CMT, celiacomesenteric trunk; LGA, left gastric artery; SA, splenic artery; SMA, superior mesenteric artery.
Figure 2
Figure 2
Unlabelled vascular reconstruction image of the contrast-enhanced CT scan of abdomen—depicting the various branches of the celiaco-mesenteric trunk.
Figure 3
Figure 3
Axial section of the contrast-enhanced CT scan image of abdomen and pelvis depicting the compression of third part of the duodenum between the SMA and the abdominal aorta. The proximal part of the duodenum is dilated (White arrow—compressed third part of the duodenum, green arrow—the dilated proximal part, red arrow—abdominal aorta, blue arrow—superior mesenteric artery). SMA, superior mesenteric artery.
Figure 4
Figure 4
Sagittal section of contrast-enhanced CT scan of the abdomen and pelvis—depicting the the aorto-CMT angle of 13 degrees. CMT, celiacomesenteric trunk.
Figure 5
Figure 5
Sagittal section of contrast-enhanced CT scan of the abdomen and pelvis—depicting the distance between aorta and the mesenteric artery (8 mm) and the compressed duodenum between the two.
See this image and copyright information in PMC

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