Organic Or Psychiatric Disease? A Misdiagnosed Superior Mesenteric Artery Syndrome - Organic Or Psychiatric Disease? A Misdiagnosed Superior Mesenteric Artery Syndrome - Open Access Pub

Superior mesenteric artery syndrome 1, 2, 3, 4 is a rare disorder characterised by a compression of the duodenum because of the reduced angle between the aorta and superior mesenteric artery. The disease is clinically characterised by abdominal pain, lack of appetite, vomiting and anorexia; some of these symptoms also characterise eating disorders. We report a case of a young female patient presenting with abdominal pain, loss of appetite and chronic loss of weight which led to misdiagnosis of anorexia nervosa; ultrasound with echo color Doppler methodology has subsequently allowed the correct diagnosis. DOI10.14302/issn.2379-7835.ijn-16-1154 A 21-year-old woman had a history of abdominal pain since the age of 18, which started after an extreme diet following a moderate weight gain following which she had lost 11 kg; during the diet she reported irritability, mood disorders, asthenia, epigastrum postprandial abdominal pain, constipation or diarrhoea. Blood tests to exclude liver, kidney, autoimmune and celiac diseases as well as instrumental tests (abdominal ultrasound, esophagogastroduodenoscopy), were performed . After medical assessments and a diagnosis of psychosomatic illness, she was prescribed several drugs acting on the central nervous system (CNS) (benzodiazepines, sulpiride) and antispasmodics mebeverine, trimebutine) without benefit; the early postprandial (15–30 minutes after a meal) pain decreased without ceasing altogether. As, however, this pain underwent a marked improvement when the patient was taking small meals, she consequently kept on this diet dividing daily food into five to six mainly solid or semi-solid small daily meals. Nevertheless, because further weight loss was reported in the following months and since this was associated with a progressive rejection of meals, and also considering the onset of sporadic amenorrhea, the patient underwent a neuro-psychiatric assessment. In fact she was diagnosed as having an eating disorder and prescribed antidepressant drugs (selective serotonin reuptake inhibitors), and support with individual and family psychotherapy was started. In spite of all of this, the patient had no benefit, as the pain, although attenuated in intensity, persisted when she ate regular meals. New blood tests and abdominal ultrasounds were performed, but no organic diseases affecting the abdominal organs were found. She was diagnosed with presumably, an ‘eating disorder in borderline avoidant personality’, and she was treated with Olanzapine. Because the abdominal pain and vomiting does not improve despite treatment,