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Superior mesenteric artery syndrome (Wilkie's syndrome) causes acute or chronic compression of the third part of the duodenum. Initially conservative treatment is tried, but on failure of treatment, duodenojejunostomy is the procedure of choice, usually done by open surgery. We present a case of superior mesenteric artery syndrome in which the duodenojejunostomy was done laparoscopically.

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In paediatric age group urolithiasis is less common with overall occurrence rate of only 2-3% of total cases. Children with urolithiasis are related with significant morbidity. Different metabolic parameters either serum or urinary gets deranged in urolithiasis. Evaluation of these parameters help in identification and diagnosis of children who are at increased risk for recurrent stone formation and can be prevented by treating these abnormalities. In this study serum and urinary metabolic risk factors for urolithiasis in children were evaluated, observed and compared. Materials and Methods: This was an observational, prospective and comparative study on fifty (n=50) children with confirmed diagnosis of urolithiasis below 12 years of either sex. Dietary history, water intake and results of laboratory findings (Serum, urinary parameters and stone analysis) were recorded, evaluated, tabulated and analysed using GraphPad Instat Software. All urine samples were obtained from patients without dietary restrictions. Results: Out of 50 children, 35 (70%) and 15 (30%) were male and female respectively. Twenty-three participants were below five years of age. On dietary habits low calcium intake and high calcium intake was seen in 60% (n=30) and 14% (n=7) respectively. 64% (n=32) children had low 24-hour urine volume due to low water intake. 64% (n=32) children had metabolic abnormality and out of them serum abnormality was found in 21 and 24-hour urinary metabolic abnormality seen in 11 children. Hypocalcaemia with normal PTH and secondary hyperparathyroidism was seen in 85.71% (n=18) and 14.29% (n=3) of children respectively. Out of 11 children with urinary metabolic abnormality, hypocitruria (n=6) was the most common followed by hypercalciuria (n=3). Stone analysis was done in 20 patients, out of which majority (n=11, 55%) of the children had calcium oxalate stone. Conclusions: Predominant finding from this study was low urine volume seen due to low water intake. Major metabolic abnormality was hypocalcaemia. Improved fluid ingestion and keeping blood calcium level at ideal level may be beneficial to avert urolithiasis in children.

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