Assessment of duodenal circular drainage in treatment of superior mesenteric artery syndrome

“…Although duodenojejunostomy is still the most frequently conducted procedure for SMAS, it has recently been reported that it does not alleviate vomiting possibly due to the reversed peristalsis which in some cases is greater than the direct peristalsis or because of gastroparesis following correction surgery. [ 11 ] Finally, laparoscopic techniques have made SMA Syndrome correction surgery feasible. [ 12 ]…”

Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery syndrome: An uncommon cause of abdominal pain mimicking gastric outlet obstruction

Shah

Naware

Thind

et al. 2013

Ann Med Health Sci Res

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Upper gastrointestinal symptoms like vomiting, abdominal pain, abdominal distention may be caused by many conditions like complicated peptic/duodenal ulcer, gastritis or hiatal hernia. However, these symptoms are uncommonly produced by superior mesenteric artery (SMA) syndrome. SMA syndrome is triggered when there is narrowing of the mesenteric angle and shortening of the aortomesenteric distance. We report a case of 42-year-old female who presented with features of gastric outlet obstruction which on further investigation was revealed as SMA syndrome. The aetiology, presentation, diagnosis and management of this unusual condition are discussed.

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“…Another technique, proposed by Yang, consists of a circular duodenal drainage method with triple anastomosis: duodenojejunal, gastrojejunal and jejunojejunal. It is indicated for patients with gastric atony, duodenal dilation greater than 8 cm H 2 O or when the intraluminal pressure is above 15 cm H 2 O [20]. In this case report, laterolateral duodenojejunostomy was performed through laparotomy but a lot of cases are being reported by laparoscopic approach including robotic assistance as well [5,21].…”

Section: Discussionmentioning

confidence: 99%

Wilkie’s Syndrome in an Adolescent: A Rare Etiology of Upper Intestinal Obstruction

Roriz-Silva¹,

Maranhão²,

Krp³

2017

Journal of Case Reports and Studies

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Wilkie's Syndrome (WS) was described in 1927 and its physiopathology is related to the formation of an abnormal acute aortomesenteric angle measuring between 7 o and 22 o . It leads to digestive symptoms due to external compression of mesentery artery against the third portion of duodenum. This is a case of WS in a young, tall and slim male patient. Three months before, he began postprandial vomiting, abdominal pain, hyporexia and weight loss. The diagnostis was made by an upper gastrointestinal series with barium contrast and confirmed by Laparotomy. Duodenojejunostomy is a well-known technique and it was successfully performed in this case. Case ReportKeywords: Wilke's Syndrome; Superior Mesenteric Artery Syndrome; Mesenteric Duodenal Compression Syndrome; Duodenal Obstruction; Surgery; Duodenojejunostomy Wilkie's syndrome or Superior Mesenteric Artery Syndrome is a rare condition of upper intestinal obstruction. In the general population, the incidence is from 0.013 to 0.3% [1]. This disorder is characterized by extrinsic compression of the third portion of the duodenum due to an abnormal acute angle between the aorta and the superior mesenteric artery, or due to presence of an overlapping of the ligament of Treitz in the retroperitoneum [1]. The syndrome has been known since 1842 and was first described by Carl Von Rokitansky [2]. In 1878, Willet reported a case of death secondary to what he named fatal vomiting [3]. In 1927, Doctor Wilkie described a series of 75 patients with the so-called "duodenal ileus", and 64 of them were submitted to duodenojejunostomy that confirmed the mechanism of extrinsic duodenal compression [4]. In most cases, the onset is insidious with postprandial nausea and vomiting, pain mainly in the epigastrium and weight loss [5]. As to diagnostic exams the gold standard examination is CT angiography and 3D-reconstruction but Upper gastrointestinal series (UGS) is a simple examination and can diagnose this syndrome as well [6]. The surgical treatment of WS should be performed after a conservative treatment that includes fluid and electrolyte replacement, hydration and appropriate nutritional support. The main surgical option is duodenojejunostomy [5,7]. The aim of this study is to report a rare case of upper bowel obstruction (Wilkie's Syndrome) in an adolescent and make important considerations about its pathophysiology, diagnosis and treatment.A male patient, 17-year of age, slim, height 1.8 meters (5 ft 11 in), weight 54 Kg (119 Ib), and BMI of 16.7. The patient presented with postprandial vomiting and abdominal pain, cramps in the mesogastrium which began three months previously and were concurrent with hyporexia and weight loss over 17 kg during that period. He was admitted to the Division of General Surgery of the Hospital de Base, in the city of Porto Velho, Brazil and physical examination showed malnutrition status with emaciation -grade 3 -according to World Health Organization. Laboratory tests revealed some alterations -low hemoglobin and albumin. An abdominal plain CT showe...

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Assessment of duodenal circular drainage in treatment of superior mesenteric artery syndrome

Cited by 15 publications

References 22 publications

A comprehensive review of superior mesenteric artery syndrome

A comprehensive review of superior mesenteric artery syndrome

Superior mesenteric artery syndrome: An uncommon cause of abdominal pain mimicking gastric outlet obstruction

Wilkie’s Syndrome in an Adolescent: A Rare Etiology of Upper Intestinal Obstruction

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