Laparoscopic duodenojejunostomy to manage small bowel obstruction due to superior mesenteric artery syndrome after Roux-en-Y gastric bypass

Andrew, Brandon D.; Hamed, Ahmed B.; Gourash, William; Ahmed, Bestoun

doi:10.1016/j.soard.2020.09.038

Cited by 4 publications

(9 citation statements)

References 8 publications

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“…The primary reported cause of this disease is the loss of the fat pad between the aorta and SMA, resulting in a narrower angle between the vessels and compression of the duodenum[ 1 , 12 ]. This syndrome can be congenital or acquired[ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patients usually register a marked weight loss of > 5 kg[ 7 ]. Less frequent reports are incriminating weight loss following surgery, secondary to bariatric surgery, esophagectomy or abdominal trauma, in its etiology[ 1 , 12 , 13 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis is based on symptoms and radiological testing[ 1 ]. It needs a high index of suspicion because of its vague and nonspecific symptoms[ 12 ]. Additionally, the measurements performed on imaging investigations must also be correlated with the clinical complaints[ 8 ], and even this diagnostic approach cannot exclude all motility disorder cases[ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another reported characteristic is epigastric pain, which worsens in the supine position[ 1 , 4 , 10 ]. A sign that can help suggest the diagnosis is the relief of the patient’s symptoms when leaning forward[ 12 ] or in the left lateral decubitus position[ 13 ]. In our case, weight loss was followed by abdominal pain, nausea, and vomiting, a vicious cycle followed by a marked reduction in weight.…”

Section: Discussionmentioning

confidence: 99%

“…There are approximately 400 cases reported in the literature. SMA syndrome diagnosed after Roux-en-Y gastric bypass has been reported for 14 cases, while one case was reported after sleeve gastrectomy[ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

Apostu¹,

Chira²,

Colcear³

et al. 2022

WJCC

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BACKGROUND Superior mesenteric artery syndrome is a disease with a complex diagnosis, and it is associated with complications that make it even harder to identify. Currently, a frequent association with psychiatric disorders has been noted. Despite numerous case reports and case series, the variability of the disease has not allowed the development of protocols regarding diagnosis and management. CASE SUMMARY A 33-year-old woman presented with abdominal pain, nausea, and bile vomiting over the last 15 mo, associated with a 15-kg weight loss over the last three months. After the onset of the symptoms, the patient was diagnosed with anxiety-depressive disorder and treated appropriately. Standard examinations excluded an organic cause, and the cause of the symptoms was considered psychogenic. The persistence of symptoms, even under treatment, prompted a computer tomography angiography examination of the abdomen and pelvis. The examination identified emergence at a sharp angle of 13.7° of the superior mesenteric artery, with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm. A diagnosis of aortomesenteric clamp was established. Surgical treatment by laparoscopic duodenojejunostomy was performed. Postoperative evolution was marked by a patent anastomosis at 1 mo, with a 10-kg weight gain and improvement of the associated anxiety. CONCLUSION This case report underlines two major aspects. One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders, with an excellent outcome when proper treatment is administered. The second aspect underlines the key role of a multidisciplinary approach and follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

Apostu¹,

Chira²,

Colcear³

et al. 2022

WJCC

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Superior mesenteric artery syndrome secondary to thyrotoxicosis

Jacobs

Pacheco

Sohail

et al. 2022

Journal of Surgical Case Reports

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Superior mesenteric artery (SMA) syndrome is defined as a narrowed space and decreased angle between the SMA and aorta leading to partial or complete obstruction of the third portion of the duodenum. SMA syndrome patients may have comorbid conditions associated with extreme weight loss, hypermetabolism or malnutrition. We present the case of a 55-year-old male with SMA syndrome due to acute weight loss secondary to thyrotoxicosis. The patient was nutritionally optimized and euthyroid prior to undergoing a robotic-assisted duodenojejunostomy. In this patient, the thyrotoxicosis was controlled medically, and he remained euthyroid postoperatively. His duodenal obstruction was relieved by the operation and he continued to gain weight appropriately.

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Nutcracker phenomenon secondary to superior mesenteric artery syndrome

Pacheco

Chacon²,

Brite

et al. 2023

Journal of Surgical Case Reports

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Superior mesenteric artery (SMA) syndrome, compression of the duodenum due to a decreased angle between the aorta and SMA, has a wide range of clinical presentations making it difficult to diagnose. Compression of the left renal vein is known as Nutcracker syndrome. We present the case of a 26-year-old male with a delayed diagnosis of SMA syndrome and Nutcracker phenomenon due to the patient’s history of chronic pancreatitis. As a result of his obstruction and aspiration pneumonia, he was diagnosed with septic shock. The patient was treated for septic shock and maintained on an enteric diet with improvement in the body mass index and complete resolution of SMA syndrome symptoms.

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Laparoscopic duodenojejunostomy to manage small bowel obstruction due to superior mesenteric artery syndrome after Roux-en-Y gastric bypass

Cited by 4 publications

References 8 publications

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

Superior mesenteric artery syndrome secondary to thyrotoxicosis

Nutcracker phenomenon secondary to superior mesenteric artery syndrome

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