Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2024; 12(29): 6327-6334
Published online Oct 16, 2024. doi: 10.12998/wjcc.v12.i29.6327
Comprehensive interventions for adult cyclic vomiting syndrome complicated by superior mesenteric artery syndrome: A case report
Bo Liu, Hui Sun, Yang Liu, Min-Lan Yuan, Hong-Ru Zhu, Wei Zhang
Bo Liu, Department of Psychiatry, Zigong Mental Health Center, Zigong 643020, Sichuan Province, China
Hui Sun, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Yang Liu, Min-Lan Yuan, Hong-Ru Zhu, Wei Zhang, Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Co-first authors: Bo Liu and Hui Sun.
Author contributions: Liu B wrote original manuscript; Sun H performed imaging examination; Liu Y, Yuan ML and Zhu HR revised the manuscript; Zhang W designed the study; all authors have read and approved the final manuscript. Liu B and Sun H contributed equally to this work as co-first authors. The designation of co-first authorship for Liu B and Sun H is based on the following reasons. Firstly, the research was conducted as a collaborative effort, with the distribution of responsibilities and efforts evenly shared between the two, accurately reflecting their equal contribution to the study and the resultant paper. Secondly, the study involved multidisciplinary cooperation, particularly in the fields of psychiatry and radiology. Liu B served as the psychiatrist responsible for addressing clinical data, while Sun H acted as the radiologist responsible for analyzing image data. Therefore, we believe that designating Liu B and Sun H as co-first authors appropriately represents our team's collaborative spirit, equal contributions, and the interdisciplinary nature of our work.
Supported by 1·3·5 Project for Disciplines of Excellence, West China Hospital, Sichuan University, No. ZYJC21004.
Informed consent statement: Informed written consent was obtained from the patient and her mother for publication of this case.
Conflict-of-interest statement: No conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Zhang, Doctor, MD, Chief Doctor, Professor, Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan Province, China. weizhanghx@163.com
Received: May 30, 2024
Revised: July 4, 2024
Accepted: July 23, 2024
Published online: October 16, 2024
Processing time: 89 Days and 18.9 Hours
Abstract
BACKGROUND

Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder involving the gut–brain interaction that is characterized by recurring episodes of nausea, vomiting, abdominal pain, and interspersed complete normal periods. Superior mesenteric artery (SMA) syndrome (SMAS) is a vascular condition in which the horizontal portion of the duodenum is compressed due to a reduced angle between the aorta and the SMA. This condition presents with symptoms similar to CVS, posing challenges in distinguishing between the two and often resulting in misdiagnosis or inappropriate treatment.

CASE SUMMARY

A 20-year-old female patient presented with recurrent episodes of vomiting and experienced a persistent fear of vomiting for the past 2 years. She adopted conscious dietary restrictions, which led to severe malnutrition. Initially, she was diagnosed with SMAS, as revealed by computed tomography angiography. Despite efforts to increase the angle between the aorta and the SMA through weight gain, her vomiting did not improve. Finally, she was diagnosed with comorbidities including CVS, SMAS and anxiety disorder. She underwent comprehensive interventions, including enteral and parenteral nutritional supplementation, administration of antiemetic and anti-anxiety agents, and participation in mindfulness-based cognitive therapy. The patient eventually experienced a notable improvement in both body weight and clinical symptoms.

CONCLUSION

We present a rare case of CVS in an adult complicated with SMAS and propose additional treatment with nutritional support, pharmacological intervention, and psychotherapy.

Keywords: Cyclic vomiting syndrome; Superior mesenteric artery syndrome; Anxiety disorder; Nutritional supplementation; Mindfulness-based cognitive therapy; Case report

Core Tip: Cyclic vomiting syndrome (CVS) is a rare gastrointestinal disorder characterized by intense, recurrent vomiting episodes. Superior mesenteric artery (SMA) syndrome (SMAS) occurs when the third part of the duodenum is compressed by the SMA, often leading to vomiting similar to CVS. Weight loss resulting from CVS can contribute to the development of SMAS, and conversely, SMAS can mimic CVS symptoms. To distinguish between these conditions, detailed clinical examination is essential, particularly with abdominal imaging. Additionally, long-term closely follow-up is necessary to differentiate between the two. Comprehensive interventions involving psychosomatic treatment are necessary to address these conditions.