Misdiagnosed superior mesenteric artery syndrome due to diabetic gastroparesis. Case report and literature review

Superior mesenteric artery syndrome (SMAS) is a rare cause of upper intestinal obstruction. This occurs due to duodenal compression between the superior mesenteric artery and the aorta. Anatomical alterations, eating disorders, after some surgical procedures, and trauma are frequent causes of this rare syndrome. Diabetes is a highly prevalent disease that can cause gastroparesis in up to 12 %. Its association with SMAS is extremely rare and challenging to identify. A 32-year-old man experienced nausea and vomiting after diagnosis and treatment for type II diabetes. He was treated for diabetic gastroparesis for 2 years without improvement until he lost 40 kg of weight. After imaging studies, a distance between the superior mesenteric artery and the aorta of 5.3 mm and an angle of 17 degrees were detected, corroborating the diagnosis of SMAS syndrome. Due to medical failure, surgical treatment via duodenojejunostomy was performed. Diabetes is a very prevalent disease in the world population that can cause gastrointestinal symptoms. In our patient, diabetic gastroparesis delayed the diagnosis of SMAS until severe symptoms of upper intestinal obstruction and significant weight loss occurred. In our patient, due to medical failure, surgical treatment significantly improved his symptoms and stopped his weight loss. Superior mesenteric artery syndrome is a rare syndrome, and challenging to differentiate from diabetic gastroparesis. Delays in management may result in excessive weight loss. Surgical treatment can improve symptoms and weight loss. •Superior mesenteric artery syndrome (SMAS) is a rare cause of upper intestinal obstruction.•Diabetes is a highly prevalent chronic disease, and its association with SMAS is exceptionally rare.•Diabetic gastroparesis makes the diagnosis of intestinal syndromes such as SMAS challenging.•Delaying the diagnosis of SMAS can lead to significant weight loss, and surgical treatment could be a good treatment option.•We present a rare case of SMAS in a type II diabetic patient misdiagnosed with gastroparesis with significant weight loss.