Case Report
Volume: 4 | Issue: 7 | Published: Jul 09, 2020 | Pages: 240 - 244 | DOI: 10.24911/ejmcr/173-1589020023
Superior mesenteric artery syndrome: a case report and a novel surgical approach
Authors: Ana Paula Fernandes Braga , Silvio Pereira Borges Junior , Daniella Montecino Vaz de Melo , Thais de Moura Braga , Helbert de Paula Pupo Nogueira , Julia Salles Rezende Dias , Thomas Diniz Moura , Vinicius Rodrigues Taranto Nunes
Article Info
Authors
Ana Paula Fernandes Braga
Post Graduate Trainee of Surgery, Hospital da Policia Militar de Minas Gerais, Belo Horizonte, Brazil
Silvio Pereira Borges Junior
Post Graduate Trainee of Surgery, Hospital da Policia Militar de Minas Gerais, Belo Horizonte, Brazil
Daniella Montecino Vaz de Melo
Post Graduate Trainee of Surgery, Hospital da Policia Militar de Minas Gerais, Belo Horizonte, Brazil
Thais de Moura Braga
Post Graduate Trainee of Surgery, Hospital da Policia Militar de Minas Gerais, Belo Horizonte, Brazil
Helbert de Paula Pupo Nogueira
Post Graduate Trainee of Surgery, Hospital da Policia Militar de Minas Gerais, Belo Horizonte, Brazil
Julia Salles Rezende Dias
Post Graduate Trainee of Surgery, Hospital da Policia Militar de Minas Gerais, Belo Horizonte, Brazil
Thomas Diniz Moura
6th year Medical student in Federal University of Minas Gerais, Medical School, Belo Horizonte, Brazil
Vinicius Rodrigues Taranto Nunes
General Surgeon, Hospital da Policia Militar de Minas Gerais, Belo Horizonte, Brazil
Publication History
Received: May 09, 2020
Revised: June 17, 2020
Accepted: June 24, 2020
Published: July 09, 2020
Abstract
Background: Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction that has non-specific and insidious symptoms. An initial treatment is conservative, and surgery is reserved for patients who continuously present with symptoms or complications. The aim of this study is to describe a combination of two surgical techniques: duodenojejunostomy and Strong's procedure (the release of the Treitz ligament) through a laparoscopic approach. This combination of both techniques has already been described, however, with a lack of technical detail. Case Presentation: This report presents the case of a 19-year-old male diagnosed with SMAS, confirmed through computed tomography and angiographic magnetic resonance imaging of the abdomen. He underwent a laparoscopic duodenojejunostomy and release of the Treitz's ligament. The patient recovered well with no complications and was discharged 5 days postoperatively. Conclusion: Due to the rarity of the disease, there is a lack of literature comparing the benefits of either of these two techniques, and also, there are no established protocols favoring the use of one procedure over the other. In this case, we combined both techniques to reduce the rate of recurrence, increase the anastomotic safety, and reduce long-term complications. However, a larger study would be necessary to establish the combined use of these two techniques.
Keywords: Superior mesenteric artery syndrome, Wilkie's syndrome, duodenal obstruction, laparoscopy, duodenojejunostomy, Strong's procedure, green
