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Q: Respected sir, my sister whose age is 18 year old..she have problem of abdominal pain and continuously vomiting(minimum 10 time in day).and vomit color is green. In the CT scan it is diagnosed that she have problem of SMA we make operation of it by surgeon.. still she have same problem.after the operation of 2 month. She have this problem since 3 years and one another notices thing is she have this problem when she is in mensis so we cant have idea..plz give us guidence...
Nainesh - Surat, India

A: Dear Nainesh, Your sister has a rare problem that can be difficult to diagnose. SMA Syndrome stands for Superior Mesenteric Artery Syndrome. The superior mesenteric artery is a branch that comes off the aorta as it goes thru the abdomen. Sometimes a portion of the small intestine, the duodenum, gets trapped between the superior mesenteric artery and the aorta and gets squeezed or pinched. Sometimes this happens from birth, from the way the artery and bowel are formed and sometimes it happens after an accident to the spine or a large weight loss. It tends to be more common in thin people, more in girls than boys and is more common if there is some problem with the spine or muscles. It sounds like your sister has the congenital form since she had problems as a 3 year old. As you have seen, this pressure on the bowel causes vomiting of bile and often spasms of pain and weight loss or poor weight gain. It can be hard to diagnose but the CT scan can show the problem. In severe, chronic cases like your sister's, surgery is the usual treatment. There are some different options for surgical correction, but I am not a surgeon so I cannot tell you how your surgeon decides which option to use. Some patients do not get better immediately after surgery, especially if the condition has been going on for a long time. This may have to do with how the bowel muscles have become used to working. I do not know why it would cause your sister more problem during her menses. I would suggest that you go back to see your surgeon and see what he suggests you do next. You might also want to see a stomach or gastrointestinal specialist if you have not seen one already. I hope that you can help your sister find relief from this serious problem. Sincerely, Sarah K Wickenkamp, MD

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