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Case Report: Minimally invasive approach to SMA syndrome with a Review of diagnostic criteria and treatment options

Lindsay Tse, DO. Houston Methodist Hospital

Superior Mesenteric Artery Syndrome is a rare and potentially life threatening entity that has a reported incidence in medical literature of 0.1 to 0.3%. SMA syndrome occurs when the third portion of the duodenum is compressed by a narrowed angle ranging from six and twenty -five degrees between the abdominal aorta and the superior mesenteric artery. The decreased angle causes a mechanical compression, which is often secondary to a lack of retroperitoneal and visceral fat. Symptoms are often nonspecific, and a definitive diagnosis is often difficult to obtain. This case report describes a 20 year old female diagnosed with superior mesenteric artery syndrome who presented for surgical consultation after years of failing medical interventions. She described an extensive history of nausea and vague post prandial abdominal pain unrelieved by numerous medical interventions including long term PPI use, diet modification, and treatment for irritable bowel syndrome. Her BMI was consistently 18 or under throughout her life, and she reported being unable to gain weight due to lack of caloric intake. Physical exam and laboratory testing were unremarkable. EGD revealed a single gastric polyp which was removed by cold snare, but was otherwise unremarkable. Upper GI demonstrated a functional stenosis at the third portion of the duodenum as it transverses the spine, and CTA abdomen/pelvis showed a discrete transition in caliber from the proximal to distal duodenum with a decreased aortomesenteric angle. Treatment options included forced increased caloric intake, jejunostomy tube placement, duodenojejunostomy, and/or ligation of the ligament of Treitz. The patient underwent a laparoscopic duodenojejunostomy using two 3mm ports and one 12mm port. At the time of surgery, the superior mesenteric artery was easily visualized, and the duodenum was nearly two times the diameter of the small bowel immediately distal to the artery. A hand sewn, two layer anastomosis was created to bypass the area of obstruction. Post operatively, the patient recovered uneventfully, and is currently tolerating a soft diet with improvement in symptoms. Minimally invasive laparoscopic duodenojejunostomy is a safe and effective treatment option for select patients with superior mesenteric artery syndrome. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95673

Program Number: P515

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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