Superior mesenteric artery syndrome: a unique complication following carboplatin-based chemotherapy

Our plain-English summary of Superior mesenteric artery syndrome: a unique complication following carboplatin-based chemotherapy, by M. Chowdhary, H.P. Pansuria, B. Farooqi, et al (International Medical Case Reports Journal, 2015).

The study

• Authors: M. Chowdhary, H.P. Pansuria, B. Farooqi, H. Goyal
• Journal: International Medical Case Reports Journal
• Published: 2015;8:55-8
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Superior mesenteric artery syndrome (SMAS) is an uncommon condition, attributable to vascular compression of the third part of the duodenum between the superior mesenteric artery and the abdominal aorta. It can present in patients due to mechanical compression or severe weight loss. We present a unique case of SMAS in a patient undergoing carboplatin-based chemotherapy for mesothelioma. An 81-year-old male with mesothelioma was treated with carboplatin-based chemotherapy. He subsequently suffered a progressive, unintentional 18 kg weight loss and presented acutely with intense epigastric pain, severe nausea, and vomiting. Diagnosis was confirmed by abdominal computed tomography and esophagogram with upper gastrointestinal series, which revealed gastric and duodenal distention and a narrow angle between the superior mesenteric artery and aorta, causing compression of the duodenum. Prompt recognition of this syndrome allowed us to treat our patient successfully and avoid the risks of operative interventions. To our knowledge, this is the first reported case of SMAS in patients receiving carboplatin. Furthermore, this case of SMAS was unique in that it was due to weight loss as compared with mechanical obstruction. Our experience illustrates the importance of considering SMAS in chemotherapy patients, especially those with substantial weight loss. A high index of suspicion for this potential complication coupled with appropriate radiographic studies are necessary for early diagnosis and can prevent severe consequences.

In plain English

This case report described one patient. An 81-year-old Caucasian man with mesothelioma, treated for the past year with carboplatin and pemetrexed chemotherapy, came to the emergency room with two days of repeated vomiting, severe nausea and upper abdominal pain. He reported an unintentional 18 kg weight loss over the previous six months and no weight loss before chemotherapy began. A CT scan showed a swollen stomach and duodenum and a narrowed angle between the superior mesenteric artery and the aorta (less than 20 degrees, against a reference of 45 to 65 degrees), with no definite mass. An X-ray contrast study confirmed superior mesenteric artery syndrome, in which part of the duodenum is compressed between these two vessels. He was treated without surgery and over 3 months gained about 5 kg, and his symptoms resolved. The authors concluded that weight loss, likely from the chemotherapy together with the cancer, led to the syndrome, and believed this was the first reported case in a mesothelioma patient. The report did not state where the mesothelioma was located or mention asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 81-year-old Caucasian man with mesothelioma and hypertension, seen in an emergency room (authors from Mercer University School of Medicine, Macon, Georgia, USA)
• Exposure: Chemotherapy with carboplatin plus pemetrexed for mesothelioma over the year before presentation. No asbestos exposure is described.
• Main results:
  • The patient reported an unintentional 18 kg weight loss over the previous 6 months.
  • The patient reported no weight loss or gastrointestinal symptoms before chemotherapy started.
  • Blood tests were unremarkable apart from low potassium (3.3 mEq/L).
  • Abdominal CT showed a narrowed angle between the superior mesenteric artery and aorta (less than 20 degrees, against a reference of 45 to 65 degrees), and no definite mass was seen.
  • No definite mass was seen on CT.
  • Management was conservative (non-surgical) because of the patient's age and malnutrition.
  • At follow-up the patient had gained about 5 kg over 3 months and his symptoms had resolved.
• The authors' conclusion: The authors concluded that the combination of carboplatin-based chemotherapy and the cancer likely caused the patient's weight loss, which they believed caused the syndrome. They believed this to be the first reported case of the syndrome in a patient with mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Carboplatin, Chemotherapy, Mesothelioma.

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