title: Minimally invasive surgery for superior mesenteric artery syndrome: A case report.
abstract: Superior mesenteric artery (SMA) syndrome is defined as a compression of the third portion of the duodenum by the abdominal aorta and the overlying SMA. SMA syndrome associated with anorexia nervosa has been recognized, mainly among young female patients. The excessive weight loss owing to the eating disorder sometimes results in a reduced aorto-mesenteric angle and causes duodenal obstruction. Conservative treatment, including psychiatric and nutritional management, is recommended as initial therapy. If conservative treatment fails, surgery is often required. Currently, traditional open bypass surgery has been replaced by laparoscopic duodenojejunostomy as a curative surgical approach. However, single incision laparoscopic approach is rarely performed. A 20-year-old female patient with a diagnosis of anorexia nervosa and SMA syndrome was prepared for surgery after failed conservative management. As the patient had body image concerns, a single incision laparoscopic duodenojejunostomy was performed to achieve minimal scarring. As a result, good perioperative outcomes and cosmetic results were achieved. We show the first case of a young patient with SMA syndrome who was successfully treated by single incision laparoscopic duodenojejunostomy. This minimal invasive surgery would be beneficial for other patients with SMA syndrome associated with anorexia nervosa, in terms of both surgical and cosmetic outcomes.
authors.affiliation: Si-Yuan Yao, Ryuichi Mikami, Department of Surgery, Kobe City Medical Center West Hospital, Nagata-ku, Kobe 653-0013, Japan.
authors.forename: Si-Yuan
authors.initials: SY
authors.lastname: Yao
authors.affiliation: Si-Yuan Yao, Ryuichi Mikami, Department of Surgery, Kobe City Medical Center West Hospital, Nagata-ku, Kobe 653-0013, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Mikami
authors.affiliation: Si-Yuan Yao, Ryuichi Mikami, Department of Surgery, Kobe City Medical Center West Hospital, Nagata-ku, Kobe 653-0013, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Mikami
mesh_terms: D000856:Anorexia Nervosa / Q000150:complications; D004385:Duodenostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy; D013478:Superior Mesenteric Artery Syndrome / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anorexia nervosa; Minimally invasive surgery; Single incision laparoscopic duodenojejunostomy; Superior mesenteric artery syndrome; Young female patient