SMA Syndrome Treated by Single Incision Laparoscopic Duodenojejunostomy

Kim, Sung Soo; Kim, Yoo Seok; Min, Young-Don

doi:10.4137/ccrep.s17553

Cited by 10 publications

(4 citation statements)

References 22 publications

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“…9 Anterior transposition of the third part of the duodenum at laparotomy is less commonly performed and requires extensive dissection and duodenal reanastomosis but has been found to be effective. 14,15 Duodenojejunostomy has been described at open, laparoscopic, and single-port surgery, 16,17 with or without division of the fourth part of the duodenum.…”

Section: Management Conservativementioning

confidence: 99%

Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice

Kirby

Faulconer

Robinson

et al. 2017

annals

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INTRODUCTION The superior mesenteric artery (SMA) syndrome, or Wilkie's syndrome, is a rare cause of postprandial epigastric pain, vomiting and weight loss caused by compression of the third part of the duodenum as it passes beneath the proximal superior mesenteric artery. The syndrome may be precipitated by sudden weight loss secondary to other pathologies, such as trauma, malignancy or eating disorders. Diagnosis is confirmed by angiography, which reveals a reduced aorto-SMA angle and distance, and contrast studies showing duodenal obstruction. Conservative management aims to increase intra-abdominal fat by dietary manipulation and thereby increase the angle between the SMA and aorta. Where surgery is indicated, division of the ligament of Treitz, anterior transposition of the third part of the duodenum and duodenojejunostomy have been described. METHODS We present four cases of SMA syndrome where the intention of treatment was laparoscopic duodenojejunostomy. The procedure was completed successfully in three patients, who recovered quickly with no short-term complications. A fourth patient underwent open gastrojejunostomy (complicated by an anastomotic bleed) when dense adhesions prevented duodenojejunostomy. CONCLUSIONS The superior mesenteric artery syndrome should be considered in patients with epigastric pain, prolonged vomiting and weight loss. Laparoscopic duodenojejunostomy is a safe and effective operation for management of the syndrome. A multi-speciality team approach including gastrointestinal, vascular and radiological specialists should be invoked in the management of these patients.

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Section: Management Conservativementioning

confidence: 99%

Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice

Kirby

Faulconer

Robinson

et al. 2017

annals

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“…Furthermore, we employed semi-Kocherization to increase duodenal mobility for performing anastomosis; therefore, we believe that this technique is very useful. A search of PubMed (https://pubmed.ncbi.nlm.nih.gov) from 1950 to September 2021 using the combined terms of “SMA syndrome,” “single-incision laparoscopic surgery,” or “single-port laparoscopic surgery” revealed that only 4 cases have been reported, including ours (Table 1) [5, 12, 13]. One of these 4 cases underwent single-port laparoscopy-assisted duodenojejunostomy, which means that the closure of the entry hole was performed via mini-laparotomy [13].…”

Section: Discussionmentioning

confidence: 99%

Single-Port Laparoscopic Duodenojejunostomy Employing Semi-Kocherization for a Young Female with Superior Mesenteric Artery Syndrome

Umemura

Nitta

Katagiri

et al. 2022

Case Rep Gastroenterol

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Single-port laparoscopic duodenojejunostomy employing semi-Kocherization performed for a patient with superior mesenteric artery (SMA) syndrome is presented in this report. A 24-year-old woman missed meals due to work pressure, and her body weight decreased from 42 kg to 27 kg within 6 months. After this severe weight loss, she suffered from postprandial abdominal pain. An enhanced computed tomography revealed that the aortomesenteric angle was 11° (narrow), and the distance was short at 4.5 mm. Duodenography also revealed dilatation of the proximal duodenum. These findings led to a diagnosis of SMA syndrome, and we performed single-port laparoscopic duodenojejunostomy. We first dissected the fusion between the duodenum and transverse mesocolon, such as Kocherization, enough to mobilize the duodenum; this procedure was termed semi-Kocherization. A gauze was placed in the dissected space for a landmark from the transverse mesocolon side. We confirmed the gauze at the duodenum’s lateral side, then opened the transverse mesocolon, and pulled the duodenum out. We performed side-to-side duodenojejunostomy. The postoperative course was unremarkable, and she gained 4 kg within 2 months of discharge. Semi-Kocherization is shown to be an effective technique to increase duodenal mobility for performing anastomosis, and single-port laparoscopic surgery can reduce wounds and increase cosmesis.

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“…Additionally, constitutional factors such as a tall, thin, body build, and anatomic anomalies including an abnormally high and fixed position of the ligament of Treitz with an upward displacing duodenum or a low origin of the superior mesenteric artery have also been implicated. 2 , 3 , 14 …”

Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery syndrome: a unique complication following carboplatin-based chemotherapy

Chowdhary¹,

Pansuria²,

Farooqi³

et al. 2015

IMCRJ

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Superior mesenteric artery syndrome (SMAS) is an uncommon condition, attributable to vascular compression of the third part of the duodenum between the superior mesenteric artery and the abdominal aorta. It can present in patients due to mechanical compression or severe weight loss. We present a unique case of SMAS in a patient undergoing carboplatin-based chemotherapy for mesothelioma. An 81-year-old male with mesothelioma was treated with carboplatin-based chemotherapy. He subsequently suffered a progressive, unintentional 18 kg weight loss and presented acutely with intense epigastric pain, severe nausea, and vomiting. Diagnosis was confirmed by abdominal computed tomography and esophagogram with upper gastrointestinal series, which revealed gastric and duodenal distention and a narrow angle between the superior mesenteric artery and aorta, causing compression of the duodenum. Prompt recognition of this syndrome allowed us to treat our patient successfully and avoid the risks of operative interventions. To our knowledge, this is the first reported case of SMAS in patients receiving carboplatin. Furthermore, this case of SMAS was unique in that it was due to weight loss as compared with mechanical obstruction. Our experience illustrates the importance of considering SMAS in chemotherapy patients, especially those with substantial weight loss. A high index of suspicion for this potential complication coupled with appropriate radiographic studies are necessary for early diagnosis and can prevent severe consequences.

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SMA Syndrome Treated by Single Incision Laparoscopic Duodenojejunostomy

Cited by 10 publications

References 22 publications

Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice

Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice

Single-Port Laparoscopic Duodenojejunostomy Employing Semi-Kocherization for a Young Female with Superior Mesenteric Artery Syndrome

Superior mesenteric artery syndrome: a unique complication following carboplatin-based chemotherapy

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