Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome
Epublication WebSurg.com, Sep 2015;15(09). URL: http://websurg.com/doi/vd01en4557
Purpose: The superior mesenteric artery (SMA) syndrome is a rare disease in which the third portion of the duodenum is compressed by the narrow space of the SMA and the aorta. Surgical treatment such as duodenojejunostomy (DJS) could resolve this problem. Here we report our experience of laparoscopic DJS with a video demonstration. Materials and Methods: This 18-year-old woman suffered from vomiting, abdominal distention and progressive weight loss during 6 months before admission. The abdominal discomfort usually occurred after meals and it could be alleviated by a decubitus position. Endoscopic exams revealed gastritis and reflux esophagitis. Computed tomography (CT) with contrast identified the distended stomach and the proximal duodenum obstructed by the SMA. Surgical treatment was advised after a complete preoperative survey, including a series of image survey, psychological evaluation and nutrition status. A three-port laparoscopic approach was used. After opening a small window through the mesocolon, a side-to-side DJS was created with a linear stapler and the common channel was closed with a hand-sewn suture. Results: There were no intraoperative complications. The laparoscopic DJS tooks 52 mins and blood loss was minimal. The nasogastric tube was removed on postoperative day 3 and she was discharged uneventfully on postoperative day 7. The postoperative upper GI series showed a smooth contrast passage from the DJS to the intestine and the patient gained 6 kg within 4 months after surgery. Conclusion: Laparoscopic DJS is a surgical option for SMA syndrome after conservative treatment failure. It is safe, feasible and provides the benefits of a minimally invasive approach.