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Neurological Rehabilitation

Superior Mesenteric Artery Syndrome as a Late Complication in Chronic TBI: A Case Report

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 5

    Poster Presenter(s)

  • Alan Cuevas Villagomez, MD (he/him/his)

    Resident Physician
    McGaw Medical Center of Northwestern University (SRAL)
    Chicago, Illinois

    • Co-Author(s)

  • KL

    Kevin Leahy, MD

    Brain Injury Fellow
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Elkins Park, Pennsylvania

  • NB

    Nenad Brkic, MD

    Attending Physician
    Shirley Ryan Ability Lab
    La Grange, Illinois

Disclosure(s):
Alan Cuevas Villagomez, MD: No financial relationships to disclose
Case Diagnosis: Super Mesenteric Artery Syndrome (SMAS) in a 25-year-old with chronic severe TBI

Case Description or Program Description: The patient was initially injured in an MVC resulting in a SDH and SAH with GCS5T. She completed AIR three months after her injury. Her spastic tetraperesis worsened leading to failure to thrive requiring a gastrostomy tube and second admission to acute inpatient rehabilitation (AIR). She weighed 73 kilograms at the time of her injury and 42 kilograms at admission to AIR (43.84% decrease). Her BMI of 16.9 was consistent with severe malnutrition. She developed new-onset nausea that rapidly progressed to nonbloody nonbilious emesis with leakage of tube feeds from her gastrostomy tube site.

Setting: Stand-alone AIR center

Assessment/Results: An abdominal CT scan showed abrupt narrowing in the third portion of the duodenum, consistent with SMAS. She underwent gastric decompression via NG tube and feeding via TPN. She continued to have emesis during attempts to reinitiate oral feeds, requiring gastrostomy to gastrojejunal conversion of her feeding tube, which allowed bypass of the obstruction. A venting port was placed on the gastric portion of the tube to allow for continued decompression. The patient tolerated the reinitiation of oral feeds.

Discussion (relevance): SMAS is a rare cause of SBO, most often seen in young female adults after rapid weight loss resulting in loss of the mesenteric fat pad between the aorta and SMA. The narrowing of the aortomesenteric angle causes compression of the duodenum, presenting vaguely with nausea and emesis. This patient's dramatic weight loss after her chronic TBI appears to have precipitated this complication, which has been described after SCI but less so in adults with TBI.

Conclusions: Early diagnosis of SMAS allowed for prompt treatment and resolution of our patient's symptoms. SMAS should be considered in patients with TBI given the rapid weight loss that occurs with muscle wasting.