Superior mesenteric artery syndrome: An often overlooked cause of abdominal pain!

OBJECTIVES: To determine the prevalence of superior mesenteric artery (SMA) syndrome in patients presenting with abdominal pains, and to evaluate computed tomographic (CT) findings needed for its diagnosis. METHODS: This retrospective record-based study was carried out at the radiology department, from January 2016 to January 2021. All young patients (aged under 25) who underwent CT scans for abdominal pains were reviewed. Post-surgery, tumor, and trauma cases were excluded. Imaging findings for SMA syndrome were recorded as 'suggestive' (reduced aortomesenteric angle and distance with proximal duodenal dilatation), 'possible' (reduced angle and distance without proximal duodenal dilatation) and 'probable' (reduction of either angle or distance). Two radiologists interpreted the findings and consensus reporting was made. Diagnoses were confirmed on clinical grounds (symptomatic improvement by specific treatment and exclusion of other diagnoses), or barium studies. Imaging findings were compared to final diagnoses. McNemar's Chi-square test was used to determine association. RESULTS: Out of 141 patients (mean age=10.8, standard deviation=4), 7 (4.9%) patients mostly females were having SMA syndromes based on 'suggestive' imaging criteria (p=0.0005), and one patient underwent surgery. CONCLUSION: Superior mesenteric artery syndrome is not an uncommon condition and should be considered in differential diagnosis of acute abdomen in young patients after excluding other diagnoses.

Magnetic resonance imaging findings in patients with initial manifestations of perianal fistulas.

BACKGROUND: Crohn's disease (CD) is a serious cause of perianal disease and the incidence is increasing in Saudi Arabia. MR imaging may document specific features that may help to foresee Crohn's disease in patients making an initial presentation. OBJECTIVE: Present MR imaging findings of perianal fistulas in patients making an initial presentation. DESIGN: Retrospective, observational. SETTING: Radiology clinic in in Dhahran. PATIENTS AND METHODS: All previously undiagnosed and untreated patients who presented for the first time to the outpatient clinics from September 2015-2018 with perianal fistulas were retrospectively evaluated. Previously diagnosed CD patients, post-surgical or intervention cases were excluded. Fistulas were categorized as low or high anal, simple or complex, and were graded per St. James University Hospital Classification. Imaging was interpreted by two experienced readers based on the Van Assche score. MAIN OUTCOME MEASURES: Fistula features on MR imaging and diagnosis of CD. SAMPLE SIZE: 171 patients. RESULTS: Of 171 patients, 139 (81.3%) were males with mean age of 37.2 (12.7) years; the 32 females had a mean age of 35.8 (10.6) years. Twenty-one patients (12.3%) had CD. Fourteen (40.4%) patients with complex fistulas had CD in comparison to only 5 (4.8%) simple fistula patients ( P=.0005). More than half of patients with complex and high anal fistulas had CD ( P=.0005). Females were more affected than males ( P=.0005). CONCLUSION: Complex or high anal fistula on MR imaging may be the initial presentation of CD and warrant further work up to establish the diagnosis. LIMITATIONS: Retrospective, small sample, single center, and short duration study. CONFLICT OF INTEREST: None.