Superior mesenteric artery syndrome (SMAS) is an uncommon condition which is difficult to diagnose due to non-specificity of symptoms. The most common causes of SMAS are severe weight loss secondary to severe medical conditions, surgical history, and cancer. A 31-year-old male with a history of ulcerative colitis status-post proctocolectomy with ileal pouch-anal anastomosis 10 years prior, presented with progressively worsening weight loss and abdominal pain. Radiographic imaging was consistent with SMAS, which was subsequently confirmed intraoperatively during an emergency surgery in which a Roux-En-Y gastrojejunostomy was performed. Clinicians should be aware that SMAS is a rare but possible complication of ileal pouch-anal anastomosis. Although rare, there should be a low threshold for this diagnosis when obstructive symptoms present.

Citations

• Superior mesenteric artery syndrome complicated with duodenal bulb–descending ulcerative stricture: a case report and literature review
  Erhua Yang, Jiajing Zhang, Zhimeng Yang, Suping Xiong, Fanming Guo, Dejiang Zhao, Xuefeng Wang
  Frontiers in Medicine.2026;[Epub]     CrossRef
• Superior mesenteric artery syndrome following colorectal surgery: a systematic review
  Nourah Alsaleh, Waed Yaseen, Renad Abo Alshamat, Raghad Aljurushi, Basem Alshareef
  Annals of Medicine & Surgery.2025; 87(5): 2763.     CrossRef

Acute mesenteric ischemia is a state in which intestinal infarction can be caused by a sudden decrease in blood flow. A 68-year-old man was transferred to Hanyang University Guri hospital with abdominal pain. A computed tomography scan performed before the transfer showed no abnormal findings. Examination and evaluation revealed abnormal electrocardiogram findings and increased troponin I. Although emergency coronary angiography was normal, the patient continued to complain of severe abdominal pain. A computed tomography scan showed occlusion of the superior mesenteric artery. Percutaneous aspiration embolectomy was successfully performed prior to surgery, and subsequent laparoscopic exploration revealed an area of bowel necrosis which was then resected. The length of the small intestine remaining after resection measured 1.6 m. On postoperative Day 6, the patient began a soft food diet and was prescribed medication after being diagnosed with atrial fibrillation. He was discharged on the 13th postoperative day without postoperative complications.