Superior mesentery artery syndrome in post-spinal cord injury masquerading as peptic ulcer disease

A 56-year-old man, who was a victim of T12 spinal cord injury with paraplegia, developed peptic ulcer disease 4 years ago with massive bleeding in which an emergent truncal vagotomy and pyloroplasty were performed. Symptomatic peptic ulcer persisted accompanied by progressive poor oral intake despite conservative medical treatment. Computed tomography revealed dilatation of the third portion of the duodenum with collapse of the proximal jejunum compatible to SMA syndrome. Duodenojejunostomy was performed to relieve the obstruction. Post-operative course is uneventful. Among patients with intractable peptic ulcer disease associated with bed-ridden spinal cord injury, superior mesenteric artery (SMA) syndrome should always be kept in mind and early surgical intervention is indicated.