Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome: intermediate follow-up results and a review of the literature

Chang, Julietta; Boules, Mena; Rodriguez, John; Walsh, R. Matthew; Rosenthal, Raúl J.; Kroh, Matthew

doi:10.1007/s00464-016-5088-2

Cited by 37 publications

(65 citation statements)

References 8 publications

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“…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]. Duodenojejunostomy represents the major surgical procedure, with approximately 80% resolution and it is easy to perform and enables appropriate inspection of the abdominal cavity.…”

Section: Discussionmentioning

confidence: 95%

“…WS affects more individuals between 18-35 years with a slight predominance in females but other authors have published WS cases in the male population as well [5]. As to age group, there are reports in children and the elderly [8].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Case Reportmentioning

confidence: 99%

“…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.…”

Section: Case Reportmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Comorbid conditions have been described in up to 88% of patients. Psychiatric diseases , weight loss , and spinal procedures are the most common risk factors .…”

Section: Discussionmentioning

confidence: 99%

Wilkie's syndrome in monozygotic twins treated by 3‐D laparoscopic duodenojejunostomy

Castro

Novillo

Vázquez

et al. 2018

Asian J Endoscop Surgery

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Minimally Invasive Surgical Approach for the Treatment of Superior Mesenteric Artery Syndrome: Long‐Term Outcomes

et al. 2020

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Background Latero-lateral duodenojejunostomy is the treatment of choice for superior mesenteric artery syndrome (SMAS). The present study analyzes the long-term outcomes in 13 patients undergoing laparoscopic surgery for SMAS. Materials and methods A retrospective study of 10 females and three males undergoing surgery between 2001 and 2013 was performed. Demographic, clinical and radiologic data and long-term surgical outcomes were recorded. In 12 patients latero-lateral duodenojejunostomy and in one patient distal laparoscopic gastrectomy with Roux-en-Y reconstruction were performed. The median age was 24 years (20-28), and the median duration of symptoms was 24 months (5-24). The most frequent symptoms were abdominal pain (n = 11; 92.3%), nausea and vomiting (n = 10; 77%) and weight loss (n = 9; 69.2%). The median operating time was 98 min (86-138) and hospital stay was 3 days (1-14). Results No reconversions occurred, and one patient experienced gastric emptying delay in the immediate postoperative period with spontaneous resolution. In four patients, SMAS was associated with severe stenosis of the celiac trunk which was treated in the same operation, and four patients presented stenosis of the left renal vein (the ''nutcracker'' phenomenon). With a median follow-up of 94 months (SD 65.3), eight patients (61.5%) had excellent results. One patient had a relapse of symptoms 4 years after surgery requiring distal gastrectomy, two patients presented delay in gastric emptying following temporary improvement and one patient experienced no improvement. Conclusions Latero-lateral duodenojejunostomy yields good results in SMAS although it requires other gastric motility disorders to be ruled out for appropriate treatment to be established.

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Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome: intermediate follow-up results and a review of the literature

Cited by 37 publications

References 8 publications

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

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

Wilkie's syndrome in monozygotic twins treated by 3‐D laparoscopic duodenojejunostomy

Minimally Invasive Surgical Approach for the Treatment of Superior Mesenteric Artery Syndrome: Long‐Term Outcomes

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