Superior mesenteric artery syndrome due to duodenal edema in a chronic renal failure patient: a case report

Abstract

A 74-year-old woman had been treated conservatively for type 2 diabetes mellitus (DM) and DM nephropathy since 2004. Her renal function gradually deteriorated, and she developed chronic renal failure (CRF) with a serum creatinine level between 2.5 and 3.0 mg/dl in 2010. She presented to our hospital with nausea and vomiting related to the progression of CRF in May 2011. An abdominal computed tomography (CT) scan showed distention of the upper digestive tract from the stomach to the third portion of the duodenum, ascites, and compression of the duodenum by the abdominal aortic artery and the overlying superior mesenteric artery (SMA), which was caused by edema along the gastrointestinal tract, in particular, at the duodenum. Therefore, she was diagnosed with SMA syndrome. Decompression of the distended upper digestive tract was achieved using a nasogastric tube, and hemodialysis was also initiated in order to adequately control her fluid balance disorder, which was thought to have induced the duodenal edema and ascites. After initiating these treatments, her condition gradually improved, and she fully recovered after approximately 2 months of treatment. Thus far, there has been no report of SMA syndrome caused by duodenal edema associated with the progression of CRF that was successfully treated by conservative treatment and the initiation of blood purification.