Robert A Grossman, MD, Fred Brody, MD, MBA. George Washington University
Introduction: Superior mesenteric artery (SMA) syndrome is a rare disorder characterized by duodenal compression between the superior mesenteric artery and aorta. Typically the third portion of the duodenum is compressed due to a loss of visceral or retroperitoneal fat causing acute angulation of the junction between the aorta and SMA. SMA syndrome is classically seen in patients who have lost weight rapidly or are immobile for long periods of time. Additionally, this syndrome is seen in patients who have undergone scoliosis surgery, a left nephrectomy, or an ileal pouch anal anastomosis. Symptoms of SMA syndrome include nausea, emesis, abdominal pain, fear of food and weight loss. Classic treatment for SMA syndrome is a lateral duodenojejunostomy; however two patients are presented who were successfully treated by alternative methods.
Methods: Two patients presented with a long-standing history of abdominal pain and gastrointestinal dysfunction. Both were found radiologically to have SMA syndrome. One was treated with a radiologically-placed gastrostomy-jejunostomy (GJ) decompression/feeding tube, and the other was treated with a laparoscopic gastrojejunostomy. The attached video demonstrates the surgical technique and summarizes the non-operative approach utilized via interventional radiology.
Results: Both patients experienced post-operative weight gain with concomitant resolution of their gastrointestinal symptoms. The patient with the GJ tube has had the tube removed and the other patient who underwent a laparoscopic gastrojejunostomy has returned to normal activities including matriculation at college.
Conclusions: SMA syndrome is a rare disorder caused by duodenal obstruction as a result of compression between the SMA and aorta. While the classically described treatment involves a duodenojejunostomy, a radiologically guided GJ tube, and a laparoscopic gastrojejunostomy, may be effective treatments in select patients with SMA syndrome.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79887
Program Number: V188
Presentation Session: Video Loop
Presentation Type: VideoLoop