Superior mesenteric artery syndrome in a 26-year-old male presenting as acute pancreatitis and portal venous gas: a case report and review of the literature.

backgroundSuperior mesenteric artery syndrome is a rare form of duodenal obstruction that usually requires nonoperative management. While individual complications such as acute pancreatitis, portal venous gas, and gastric emphysema have been reported, the simultaneous occurrence of this triad in a single patient with superior mesenteric artery syndrome has never been documented. This case is novel as it highlights the successful nonoperative management of superior mesenteric artery syndrome despite the presence of these severe, potentially life-threatening complications. CASE PRESENTATION: A 26-year-old Asian male with a constitutional low body mass index of 14.53 kg/m

conclusionsThis case demonstrates that the presence of portal venous gas and gastric emphysema in superior mesenteric artery syndrome, which typically raises suspicion for gastrointestinal necrosis, can be successfully managed conservatively if clinical signs of perforation or sepsis are absent. Clinicians should maintain a high index of suspicion for the complex presentations of superior mesenteric artery syndrome and prioritize aggressive nonoperative nutritional support, as it can resolve obstruction and preclude the need for surgery even in the setting of severe multi-systemic complications.