Abstract
RATIONALE: Superior mesenteric artery (SMA) Syndrome is a rare gastrointestinal disorder caused by compression of the third part of the duodenum between the SMA and the aorta due to a reduced aortomesenteric angle. While most cases are sporadic, familial patterns suggest a possible genetic predisposition. This report presents a case of SMA syndrome in a 16-year-old male, with a familial occurrence, raising suspicion of possible genetic correlation. PATIENT CONCERNS: A 16-year-old male presented with chronic food intolerance, bilious vomiting, early satiety, and epigastric pain for over 4 years, along with significant weight loss (37-30 kg). His symptoms were exacerbated postprandially and improved with positional changes. DIAGNOSES: Ultrasound raised suspicion of SMA compression, which was confirmed by contrast-enhanced computed tomography imaging showing a reduced aortomesenteric angle of 18.2° consistent with SMA syndrome. INTERVENTIONS: Conservative management, including nutritional support and proton pump inhibitors, failed to alleviate symptoms. Therefore, the patient underwent laparoscopic Roux-en-Y gastrojejunostomy without complications. OUTCOMES: The patient tolerated a full fluid diet postoperatively, experienced regular bowel movements, and was discharged 3 days after surgery. Follow-up care included imaging, endoscopy, and laboratory testing to monitor nutritional and metabolic status. LESSONS: This case highlights the potential familial predisposition to SMA syndrome, emphasizing the need for further studies on genetic components. It also emphasizes the importance of early diagnosis and individualized management strategies, including surgical interventions, for refractory cases.