Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome.
BACKGROUND
Superior mesenteric artery (Wilkie's) syndrome is a rare condition. Only 400 cases have been reported so far. The symptoms may be acute or chronic, the chronic form being more common. Vomiting is the most common symptom. About 15 causal factors have been found. Conservative management is the rule for acute cases. Surgery is indicated for chronic cases and failure of conservative management. Laparoscopy has been used in only 8 cases so far.


METHODS
We report the ninth case of superior mesenteric artery syndrome managed by laparoscopic duodenojejunostomy. The patient was a 14-year-old boy with chronic symptoms since childhood. The procedure was relatively straightforward. The case is being reported for its rarity and the possibility of laparoscopic management.


CONCLUSIONS
Laparoscopic severing of Treitz's ligament is another surgical option, though gastrojejunostomy is of no use. Conservative management is useful only in acute cases.


CONCLUSIONS
Duodenojejunostomy is the procedure of choice and is effective in 90% of patients. We conclude that it is very effective in this condition, especially laparoscopically.
Palanivelu
Chinnusamy
C
GEM Hospital, Ramnathapuram, Coimbatore, India.
Rangarajan
Muthukumaran
M
Senthilkumar
Rangaswamy
R
Parthasarathi
Ramakrishnan
R
Jani
Kalpesh
K
D000293:Adolescent; D001466:Barium Sulfate / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004385:Duodenostomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy; D008297:Male; D013478:Superior Mesenteric Artery Syndrome / Q000175:diagnosis / Q000601:surgery*
D003287:Contrast Media; D001466:Barium Sulfate