Laparoscopic duodenojejunostomy for treatment of superior mesenteric artery syndrome.
OBJECTIVE
Superior mesenteric artery (SMA) syndrome is a rare disorder, recognized as weight loss, nausea, vomiting, and post-prandial pain due to compression and partial obstruction of the third portion of the duodenum by the SMA. If conservative treatment fails, then laparotomy with duodenojejunostomy or lysis of the ligament of Treitz is indicated. Recently, laparoscopic division of the retroperitoneal attachments of the duodenum has been described. We report the first case of laparoscopic duodenojejunostomy as the definitive treatment of vascular compression of the duodenum.


METHODS
A very thin woman with a diagnosis of SMA syndrome was prepared for surgery after having failed medical therapy. The patient was placed in a supine position, and four laparoscopic ports were required to perform a 5 cm duodenojejunostomy.


RESULTS
The patient did well postoperatively. A gastrograffin study revealed no leak with patency of the duodenojejunal anastomosis. She was subsequently discharged home on a regular diet on postoperative day four.


CONCLUSIONS
Laparoscopic duodenojejunostomy is a viable option to treat vascular compression of the duodenum. It provides definitive treatment while preserving the benefits of minimally invasive surgical techniques in the debilitated patient.
Gersin
K S
KS
Department of General Surgery, Cleveland Clinic Foundation, OH, USA.
Heniford
B T
BT
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D004385:Duodenostomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D013478:Superior Mesenteric Artery Syndrome / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome