Case Report of Novel Endoscopic Findings in SMA Syndrome Demonstrated by Video Endoscopy: Visibly Pulsating, Band-Like, Compression in Third Portion of Duodenum, with the Pulsations Corresponding One-for-One with the Radial Pulse and EKG Cycle

  • Mitchell S. CappellEmail author
  • Mihajlo Gjeorgjievski
  • Molly Orosey
case report


Superior mesenteric artery (SMA) syndrome consists of partial/complete small bowel obstruction (SBO) at the third portion of duodenum from SMA compression. Although this syndrome has characteristic, well-documented, radiologic findings as described below [1, 2], the endoscopic findings are currently not well characterized. Comprehensive literature review revealed one report of pulsatile compression at esophagogastroduodenoscopy (EGD) in SMA syndrome, as documented by one still endoscopic photograph [3]. The current case report confirms and advances this prior report by demonstrating band-like, bounding, visibly pulsating extrinsic compressions at third portion of duodenum, documented by video endoscopy and by one-for-one correspondence between these pulsations with the radial pulse and electrocardiographic QRS complex. This novel report advances the endoscopic characterization and pathophysiology of this syndrome.

Case Report

An asthenic, 22-year-old, woman without...


Superior mesenteric artery (SMA) syndrome Small bowel obstruction (SBO) Duodenal obstruction Vascular compression Esophagogastroduodenoscopy Endoscopic videography Pulsatile compressions of duodenum 


Author’s contributions

Dr. Cappell treated the patient and wrote the bulk of the paper. Drs. Mihajlo Gjeorgjievski and Molly Orosey also treated the patient and wrote part of the case report section.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest. In particular, Dr. Cappell, as a consultant of the United States Food and Drug Administration (FDA) Advisory Committee for Gastroenterology Drugs, affirms that this paper does not discuss any proprietary confidential pharmaceutical data submitted to the FDA and reviewed by Dr. Cappell. Dr. Cappell is also a member of the speaker’s bureau for AstraZeneca and Daiichi Sankyo, co-marketers of Movantik. Dr. Cappell has had one-time consultancies for Mallinckrodt and Shire in the past. This work does not discuss any drug manufactured or marketed by AstraZeneca, Daiichi Sankyo, Shire, or Mallinckrodt.

Supplementary material

Video-endoscopy demonstrates that the cyclic narrowing is visibly pulsating; one-for-one with the palpated radial pulse; and one-for-one with the electrocardiographic cycle (with peak luminal narrowing occurring after the electrocardiographic QRS complex with a brief lag) (WMV 3216 kb)

10620_2019_5472_MOESM2_ESM.docx (30 kb)
Supplementary material 2 (DOCX 15 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology and Hepatology, Department of MedicineWilliam Beaumont HospitalRoyal OakUSA
  2. 2.Division of Gastroenterology and Hepatology, Department of MedicineOakland University William Beaumont School of MedicineRoyal OakUSA

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