Chaya Shwaartz, MD, Lyn Gilad, Mustapha Siddiq, Yuri Goldes, MD. Sheba Medical Center, Israel
This is a video presentation of a 20-year-old male that developed superior mesenteric artery syndrome and was managed laparoscopically.
This is a 20-year-old male, with no past medical or surgical history. The patient had major trauma with multiple limbs fractures, chest and head injury. A week following his presentation he was complaining of food intolerance, epigastric pain, nausea, vomiting, and had no bowel movement. Barium study and a CT scan showed compression of the duodenum and an aortomesentric angle of less than 25 degrees. Narrowing of the third part of the duodenum due to extrinsic compression is seen on upper GI endoscopy.
Non surgical management with NGT, Prokinetic medications, and Post prandial positioning was unsuccessful. The patient was taken to surgery. A duodenojejunostomy was done laparoscopically. He was doing well following surgery.
SMA syndrome is a rare entity that causes bowel obstruction. SMA syndrome Caused by compression of 3rd part of the duodenum between the SMA and the aorta. The aortomesentric angle is narrowed. The narrowed angle can be due to: anomalous anatomy, loss of retroperitoneal fat. The Presentation can be with chronic symptoms of recurrent epigastric pain, bilious vomiting, early satiety and loss of weight. However, acute presentation is seen in patients who have suffered a recent rapid weight loss or a major trauma.We believe that duodenojejunostomy is the best management of patients with SMA syndrome following failure of conservative treatment and that minimally invasive surgery is beneficial.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87431
Program Number: V261
Presentation Session: Friday Video Loop (Non CME)
Presentation Type: VideoLoop