title: Robotic duodenojejunostomy for superior mesenteric artery syndrome in a teenager.
abstract: Superior mesenteric artery syndrome (SMAS) involves vascular compression of the third part of the duodenum, eventually leading to gastrointestinal obstruction. Duodenojejunostomy is indicated after failure of conservative management and in chronic cases. We report a case of a cachetic 16-year-old girl with dyskeratosis congenita who suffered from SMA syndrome for 18 months. Upper endoscopy and preoperative imaging (upper GI series and abdominal CT scan) confirmed the diagnosis. A da Vinci-assisted duodenojejunostomy was performed after obtaining informed consent from the patient and her parents. Intraoperatively, a dilated duodenum to the level of D3 was noted. A side-to-side two-layer handsewn anatomosis was performed. The patient was discharged home on postoperative day #3. She gained 1.4 kg within 1 month. Twenty-one months later, she remains asymptomatic with a total weight gain of 3.2 kg. To our knowledge, this is the first reported case of a robot-assisted duodenojejunostomy for SMAS.
authors.affiliation: Division of Pediatric Surgery, Children's Hospital of Western Ontario, 800 Commissioner's Rd East, Suite E6-208, London, ON, N6A 4G5, Canada. Andreana.Butter@lhsc.on.ca.
authors.forename: Andreana
authors.initials: A
authors.lastname: Bütter
authors.affiliation: Division of General Surgery, London Health Sciences Centre, The University of Western Ontario, London, ON, Canada.
authors.forename: Shiva
authors.initials: S
authors.lastname: Jayaraman
authors.affiliation: Division of General Surgery, London Health Sciences Centre, The University of Western Ontario, London, ON, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Schlachta
keywords: Duodenojejunostomy; Superior mesenteric artery syndrome; da Vinci surgical system