Superior mesenteric artery syndrome: a vicious cycle.

A middle-aged cachectic woman with significant medical history of quadriplegia, chronic osteomyelitis, chronic obstructive pulmonary disease, kyphoscoliosis and malnutrition presented with 3 days of persistent nausea and vomiting, absolute constipation and increasing abdominal distention. She has had similar episodes in the recent past, which were milder in nature, and were diagnosed as gastroenteritis. She was hypotensive (blood pressure 86/60 mm Hg) and tachycardic (130 bpm) on arrival, with a grossly distended abdomen and active vomiting. Initial blood tests detected hypokalaemia (K+ of 3.0 mmol/L), a raised white cell count of 23.4×109/L and features of acute kidney injury. A nasogastric tube was inserted and over a litre of bilious gastric contents was immediately aspirated.A non-contrast CT scan of the abdomen and pelvis was performed (as the patient is allergic to iodine contrast), which demonstrated marked …