Superior mesenteric artery syndrome after laparoscopic Roux-en-Y gastric bypass for morbid obesity.
Gastrointestinal obstructive complications after laparoscopic Roux-en-Y gastric bypass (LRYGBP) are not uncommon. Their usual causes are strictures, internal hernias and adhesions. Superior mesenteric artery (SMA) syndrome is a rare disorder caused by compression of the third portion of the duodenum by the SMA that can occur after rapid weight loss. This has been reported in patients with scoliosis, burns, immobilization in body casts, and idiopathic weight loss. SMA syndrome following bariatric surgery has not been reported. We present 3 cases of SMA syndrome after LRYGBP and extensive weight loss. Two patients underwent laparoscopic duodenojejunostomy and the third patient was treated with intravenous hyperalimentation. All three are symptom free at 4-18 months follow-up. The diagnosis of SMA syndrome should be considered in bariatric surgery patients with rapid weight loss who develop atypical, recurrent obstructive symptoms not attributable to other common causes.
Department of Surgery, Temple University School of Medicine Clinical Campus at The Western Pennsylvania Hospital, Pittsburgh, PA 15224, USA.
David
D
Goitein
Daniel J
DJ
Gagné
Pavlos K
PK
Papasavas
Ramsey
R
Dallal
Brian
B
Quebbemann
Josef K
JK
Eichinger
Douglas
D
Johnston
Philip F
PF
Caushaj
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D004386:Duodenum / Q000601:surgery; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007583:Jejunum / Q000601:surgery; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery*; D013478:Superior Mesenteric Artery Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D015431:Weight Loss