Superior Mesenteric Artery Syndrome in Patients with Crohn’s Disease: A Description of 2 Cases Studied with a Novel Magnetic Resonance Enterography (MRE) Procedure
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Educational Purpose (only if useful for a systematic review or synthesis), Rare co-existance of disease or pathology
Giuseppe Cicero, Tommaso D'Angelo, Antonio Bottari, Giuseppe Costantino, Carmela Visalli, Sergio Racchiusa, Maria Adele Marino, Marco Cavallaro, Luciano Frosina, Alfredo Blandino, Silvio Mazziotti
(Section of Radiological Sciences – Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Messina, Italy)
Am J Case Rep 2018; 19:431-437
Superior mesenteric artery syndrome is caused by vascular compression of the third portion of the duodenum between the aorta and the superior mesenteric artery. It may occur with acute or chronic symptomatology, such as vomiting or postprandial abdominal pain, and it is usually caused by a lack of mesenteric fat pad under conditions of severe weight loss. Crohn’s disease can be one of them.
CASE REPORT: We report 2 cases of Crohn’s disease patients with clinical suspicion of jejunal stricture who underwent MR-enterography with a novel approach. In fact, the examinations were performed including prone position of the patients inside the scanner, drinking of contrast medium during the examination, and prompt acquisition of fluoroscopic sequences. Both the exams showed an abrupt termination of the duodenum on its third portion and a decreased aortomesenteric distance, allowing the diagnosis of superior mesenteric artery syndrome.
CONCLUSIONS: A correlation between Crohn’s disease and superior mesenteric artery syndrome has never before been reported in the literature. The present study provides some practical steps that may be useful in order to improve MRE standard protocol in recognizing this condition while evaluating Crohn’s disease bowel lesions.
Keywords: Crohn Disease, Magnetic Resonance Imaging, Superior Mesenteric Artery Syndrome