Laparoscopic Roux‐en‐Y duodenojejunostomy for superior mesenteric artery syndrome in a 6‐year‐old girl: A case report of a new minimally surgical technique for children

Abstract

We present the first case report of laparoscopic Roux-en-Y duodenojejunostomy utilizing minimally invasive surgery to treat superior mesenteric artery syndrome in a child. A 6-year-old girl presented with a 3-year history of intermittent postprandial epigastric pain and anorexia. An upper gastrointestinal series revealed dilatation of the first and second parts of the duodenum and an abrupt vertical cut-off at the third portion. Despite conservative treatment for 7 weeks, there was no resolution of her symptoms, so the decision was made to proceed with a laparoscopic Roux-en-Y duodenojejunostomy. On follow-up 9 months later, there had been no recurrence of her symptoms.

Laparoscopic options in superior mesenteric artery syndrome in children: systematic review

“…The literature search revealed 702 papers, with 12 studies meeting the inclusion criteria [8][9][10][11][12][13][14][15][16][17][18][19], as detailed in the flow diagram ( Fig. 1).…”

“…SMAS confirmation can be given by upper gastrointestinal series (UGI), Doppler ultrasound, computed tomography and magnetic resonance. [8,[12][13][14] In general, these exams show dilation of the stomach and proximal duodenum with signs of extrinsic compression of its third part and a decreased aortomesenteric angle [18]. Abdominal angiography can also be performed, but, as a much more invasive diagnostic tool, is rarely used [12].…”

“…The maneuvers can be "tested" on UGI, observing if prone, left lateral decubitus or knee-chest position relieves the obstruction [13]. Up to date, there are no irrefutable data on the appropriate duration of medical treatment before the consideration of surgical correction for children with SMAS [12,16].…”

“…For patients unresponsive to conservative management, and for those with complications such as peptic ulcer, surgical options are available, and consist of bypass procedures or duodenal mobilization. They include open or laparoscopic duodenojejunostomy, gastrojejunostomy, Ladd's procedure and Strong's operation [4,7,12,27].…”

Wilkie's syndrome in monozygotic twins treated by 3‐D laparoscopic duodenojejunostomy

“…In addition, we agree with other surgeons that asking adolescent patients to have a nasojejunal tube for several weeks is very difficult . Several alternative surgical approaches have been described in the literature: duodenal derotation , laparoscopic duodenojejunostomy , robot‐assisted laparoscopic duodenojejunostomy , Strong's procedure , and laparoscopic Roux‐en‐Y duodenojejunostomy . According to the literature, laparoscopic duodenojejunostomy is the technique of choice for SMA syndrome .…”