SMA syndrome: management perspective with laparoscopic duodenojejunostomy and long-term results

Jain, Nikhil; Chopde, Amit; Soni, Banshidhar; Sharma, Bhuwanesh; Saini, Savita; Mishra, Siddharth; Mishra, Subhash; Gupta, Rajkumar; Bhojwani, Rajesh

doi:10.1007/s00464-020-07598-1

Cited by 22 publications

(28 citation statements)

References 31 publications

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“…Third, there are several potential complications associated with surgery on patients with anorexia nervosa. Laparoscopic duodenojejunostomy for SMA syndrome can reportedly induce paralytic ileus and leakage [ 14 , 15 ]. Severe malnutrition is detrimental to the outcome of surgery [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

A clinical course of a patient with anorexia nervosa receiving surgery for superior mesenteric artery syndrome

et al. 2021

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Background Superior mesenteric artery (SMA) syndrome is a well-known but relatively rare complication of anorexia nervosa. Although several reports have proposed surgery for SMA syndrome associated with anorexia nervosa, these have shown poor outcomes or did not reveal the long-term weight course. Thus, the long-term effectiveness of surgery for SMA syndrome in such cases remains unclear. This case report describes a patient with anorexia nervosa who underwent surgery for SMA syndrome. Case presentation An 18-year-old woman presented with anorexia nervosa when she was 16 years old. She also presented with SMA syndrome, which seemed to be caused by weight loss due to the eating disorder. Nutrition therapy initially improved her body weight, but she ceased treatment. She reported that symptoms related to SMA syndrome had led to her weight loss and desired to undergo surgery. Laparoscopic duodenojejunostomy was performed, but her body weight did not improve after the surgery. The patient eventually received conservative nutritional treatment along with psychological approaches, which led to an improvement in her body weight. Conclusions The case implies that surgery for SMA syndrome in patients with anorexia nervosa is ineffective for long-term weight recovery and that conservative treatment can sufficiently improve body weight; this is consistent with the lack of evidence on the topic and reports on potential complications of surgery. Due to difficulties in assessing psychological status, consultation with specialists on eating disorders is necessary for treating patients with severely low body weight.

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Section: Discussionmentioning

confidence: 99%

A clinical course of a patient with anorexia nervosa receiving surgery for superior mesenteric artery syndrome

et al. 2021

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“…Laparoscopic duodenojejunostomy is a surgical method well reported for SMA syndrome. Single-center case series show no mortality, no anastomotic leaks, and a mean post-operative length of stay ranging from 4.5 to 7.5 days [ 1 , [9] , [10] , [11] , [12] , [13] ] ( Table 1 ). There are also literature reports on laparoscopic duodenojejunostomy performed on malignant duodenal strictures, in which food intake was achieved within a week [ 2 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“… Source Number of Patients (LDJ performed) Mean length of stay (days) Anastomotic leak Mortality Complication (number of cases) Vomiting/Nausea in postoperative follow-up (vomit/nausea) Kirby et al [ 1 ] 4 (3) 7.5 none none gastroparesis (1) 1/0 ulcer bleeding at anastomosis (1) Valiathan et al [ 11 ] 6 (3) N.A. none none none 2/0 Chang et al [ 9 ] 18 (16) 6.7 none none prolonged ileus (2) 1/4 intolerance to oral intake (2) closed loop obstruction (1) Jain et al [ 10 ] 22 (22) 7.27 none none delayed gastric emptying (4) 0/0 ileus (1) Pator Peinado et al [ 12 ] 4 (4) …”

Section: Discussionmentioning

confidence: 99%

Laparoscopic duodenojejunostomy requiring a side-to-side jejunojejunostomy in malignant stenosis of the gastrojejunal anastomosis in jejunal cancer: A case report

Matsui

Murakami

Ishida

et al. 2020

International Journal of Surgery Case Reports

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Highlights Laparoscopic duodenojejunostomy is a common intervention for the stricture of the distal duodenum. Not all patients respond to this intervention, and methods to treat them must be discussed. Opioid-induced bowel dysfunction caused fluids to accumulate in the jejunal loop in our case. Jejunojejunostomy was a solution to treat our patient.

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“…Se reafirmó con un SEGD la misma patología (imágenes 4 y 5) por lo cual se mantuvo con SNG por 15 días, protección gástrica y se planteó la posibilidad de una intervención quirúrgica; por los siguientes motivos, incluyendo la falla en el tratamiento médico nutricional previo 3,4 , IMC menor a 18 23,26 , imágenes de dilatación crónica, sin cambios tanto a nivel duodenal como gástrico durante dos años 5,24 y reflujo bilioentérico observado en el SEGD en la fase dinámica 7,27 . Actualmente en algunos centros se considera la cirugía como primera opción debido al menor gasto de recursos, tasas de éxito mayores en relación al tratamiento médico y por la posibilidad de menor tiempo internación hospitalaria 28 .…”

Section: Discussionunclassified

“…Existen varias soluciones quirúrgicas a realizarse tanto por vía convencional 5 como por vía mínimamente invasiva (laparoscópica y robótica) 2,3,12 y cada una con sus ventajas y desventajas asociadas. Los procedimientos más comunes son la duodenoyeyunostomía laterolateral 15,19 que presenta un éxito mayor al 90% tanto por vía convencional como por cirugía mínimamente invasiva 2,8,10,28 ; sus desventajas son fuga y estenosis de la sutura. Desrotación de duodeno (procedimiento de Strong) 15,12 , con un éxito mayor al 80%, sin pérdida de la continuidad intestinal pero con mayor riesgo de vólvulo duodenal en un 8% de pacientes.…”

Section: Discussionunclassified

Oclusión gastroduodenal crónica por síndrome de Wilkie: reporte de un caso

Morejón

Fossati

Dogliotti

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El síndrome de Pinza Aortomesentérica o "Síndrome de Wilkie" es una entidad muy rara, se caracteriza por una pérdida de peso importante y vómitos de alimentos parcialmente digeridos. La sospecha diagnóstica se fundamenta por la presencia de factores predisponentes y/o de riesgo. Estudios imagenológicos como un esofagogastroduodeno seriado y ecografía Doppler permiten su confirmación. El tratamiento primario se apoya en una adecuada nutrición. Frente al fracaso del tratamiento médico, se indica el manejo quirúrgico con diferentes técnicas para resolver la oclusión. Se presenta el caso de una adolescente con oclusión gastroduodenal crónica, fallo en el tratamiento médico y resolución quirúrgica con buenos resultados. Palabras claves: Síndrome de la arteria mesentérica superior, obstrucción duodenal, reflujo duodenogástrico, laparotomía, anastomosis quirúrgica; gastroparesia.

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SMA syndrome: management perspective with laparoscopic duodenojejunostomy and long-term results

Cited by 22 publications

References 31 publications

A clinical course of a patient with anorexia nervosa receiving surgery for superior mesenteric artery syndrome

A clinical course of a patient with anorexia nervosa receiving surgery for superior mesenteric artery syndrome

Laparoscopic duodenojejunostomy requiring a side-to-side jejunojejunostomy in malignant stenosis of the gastrojejunal anastomosis in jejunal cancer: A case report

Oclusión gastroduodenal crónica por síndrome de Wilkie: reporte de un caso

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