We report the case of a 19-year-old military trainee that presented to the emergency department with a 3-week history of diffuse abdominal pain, 1 to 2 hours postprandially. The timing, onset, quality, and location of her pain was concerning for intestinal angina. Her serum chemistry, hematology, and liver function tests were normal. The radiologist's interpretation of the computed tomography angiogram of the abdomen was an abnormally narrow takeoff angle of the superior mesenteric artery (SMA) from the aorta near the third portion of the duodenum. She was diagnosed with SMA syndrome and received additional evaluation and treatment by her gastroenterologist and surgeon. SMA syndrome is rare and can cause bowel obstruction, perforation, gastric wall pneumatosis, and portal venous gas formation. Computed tomography angiography can be used to promptly diagnose this syndrome in the emergency department.
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