Case Report of Novel Endoscopic Findings in SMA Syndrome Demonstrated by Video Endoscopy: Visibly Pulsating, Band-Like, Compression in Third Portion of Duodenum, with the Pulsations Corresponding One-for-One with the Radial Pulse and EKG Cycle

Superior mesenteric artery (SMA) syndrome consists of partial/complete small bowel obstruction (SBO) at the third portion of duodenum from SMA compression. Although this syndrome has characteristic, well-documented, radiologic fndings as described below [1, 2], the endoscopic fndings are currently not well characterized. Comprehensive literature review revealed one report of pulsatile compression at esophagogastroduodenoscopy (EGD) in SMA syndrome, as documented by one still endoscopic photograph [3]. The current case report confrms and advances this prior report by demonstrating band-like, bounding, visibly pulsating extrinsic compressions at third portion of duodenum, documented by video endoscopy and by one-for-one correspondence between these pulsations with the radial pulse and electrocardiographic QRS complex. This novel report advances the endoscopic characterization and pathophysiology of this syndrome.