Date Posted: June 11, 2026

Author/s: James Dominic M. Cruz, MD

Superior mesenteric artery (SMA) syndrome is an uncommon condition that involves compression of the third portion of the duodenum, which is the upper part of the small intestines just past the stomach. This condition occurs when the third part of the duodenum is compressed between two arteries—the main artery of the body called the abdominal aorta (AA) and one of its branches called the SMA. The SMA provides blood supply to the small intestines and the first part of the colon. Compression of the SMA against the AA can prevent duodenal contents from draining into the jejunum (upper small intestine), hence the inability to get proper nutrition, leading to weight loss and malnutrition.

Appendicitis is the most common indication for emergency abdominal surgery in childhood and is diagnosed in 1 to 8 percent of children evaluated urgently for abdominal pain. In the United States, the incidence increases from an annual rate of one to six per 10, 000 children between birth and four years of age to 19 to 28 per 10,000 children younger than 14 years. It is frequent mostly in the second decade of life. Common signs and symptoms include anorexia, periumbilical pain (early), vomiting after onset of pain and migration to lower quadrant.

This report would primarily address a case of superior mesenteric artery syndrome and its complexities. Due to the condition’s nebulous and non-specific presenting symptoms, it was initially believed to be early appendicitis. Also discussed here is how imaging modalities, in particular contrast-enhanced CT scans, can be used to diagnose and assist in patient management.

Keywords:
Superior mesenteric artery syndrome, acute appendicitis