{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T04:29:00Z","timestamp":1777436940880,"version":"3.51.4"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":37,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Superior mesenteric artery syndrome\u00a0is a rare form of duodenal obstruction that usually requires nonoperative management. While individual complications such as acute pancreatitis, portal venous gas, and gastric emphysema have been reported, the simultaneous occurrence of this triad in a single patient with superior mesenteric artery syndrome has never been documented. This case is novel as it highlights the successful\u00a0nonoperative management\u00a0of superior mesenteric artery syndrome despite the presence of these severe, potentially life-threatening complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 26-year-old Asian male with a constitutional low body mass index of 14.53\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      presented with abrupt epigastric pain and bilious vomiting. Investigations revealed a diagnosis of superior mesenteric artery syndrome complicated by\u00a0acute pancreatitis,\u00a0portal venous gas, and\u00a0gastric emphysema. The patient was treated nonoperatively with intensive care support, including nasogastric decompression and total parenteral nutrition. The interventions led to a significant reduction in gastric output, resolution of acute kidney injury and pain, and subsequent removal of the nasogastric tube. The patient was discharged well and showed no signs of obstruction at the 9-month follow-up, having gained weight.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case demonstrates that the presence of portal venous gas and gastric emphysema in superior mesenteric artery syndrome, which typically raises suspicion for gastrointestinal necrosis, can be successfully managed conservatively if clinical signs of perforation or sepsis are absent. Clinicians should maintain a high index of suspicion for the complex presentations of superior mesenteric artery syndrome and prioritize aggressive nonoperative nutritional support, as it can resolve obstruction and preclude the need for surgery even in the setting of severe multi-systemic complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13256-026-05934-y","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T10:39:04Z","timestamp":1772620744000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Superior mesenteric artery syndrome in a 26-year-old male presenting as acute pancreatitis and portal venous gas: a case report and review of the literature"],"prefix":"10.1186","volume":"20","author":[{"given":"Witchapas","family":"Punyanirun","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pakkapol","family":"Sukhvibul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Issaree","family":"Laopeamthong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wisit","family":"Kasetsermwiriya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5373-7362","authenticated-orcid":false,"given":"Suphakarn","family":"Techapongsatorn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"5934_CR1","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1016\/j.ijscr.2019.12.043","volume":"67","author":"SH Yale","year":"2020","unstructured":"Yale SH, Tekiner H, Yale ES. 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Patient consent was obtained, however, the confidentiality of the participant was kept secret and was used only for this publication without patient identification.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"181"}}