The importance of a correct nutritional management in SMA syndrome associated with a restrictive eating disorder: a case-report
Keywords:
Superior mesenteric artery syndrome, Nutritional management, Eating disordersAbstract
Superior mesenteric artery syndrome (SMAs), is an uncommon disease characterized by the compression of the third portion of duodenum in an anatomical compass created by the reduction of the aortomesenteric angle. It is most frequently an acquired condition, generally caused by perivascular fat thinning after rapid weight loss, as in eating disorders. SMAs causes early satiety, acute abdominal pain and distension which lead to food intake restriction and further weight loss creating a vicious cycle that overlaps eating disorders’ symptoms.
The first line therapy is conservative and a correct nutritional management is crucial to avoid surgical treatment.
Our patient is a seventeen-year old female who, after a rapid weight loss due to EBV infection, developed acute post-prandial abdominal pain resulting in food intake rejection. The diagnostic suspect was raised by abdominal doppler US and confirmed by MR angiography.
We started enteral nutrition via NG Tube and gradually transitioned to an exclusive oral refeeding in order to obtain a better compliance and to avoid complications. To achieve this goal we started by introducing small amounts of food and by gradually increasing its consistency and quantity.
As a result we decreased and then stopped the enteral nutrition with good tolerance of our patient.
In young females affected by eating disorders SMAs should be suspected, especially in case of fast weight loss and food intake rejection. The key to a good therapeutic outcome is a multidisciplinary approach based on personalized nutritional plan and psychological support in the refeeding process.
References
ASST Fatebenefratelli Sacco, Pediatric Unit, Milan, Italy
Pediatric Department, Buzzi Children’s Hospital,Milan, Italy
Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Grandam Ospedale Maggiore Policlinico, Via Francesco Sforza 35 – 20122, Milan, Italy
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