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Case Report

EJMCR. 2020; 4(7): 240-244

Superior mesenteric artery syndrome: a case report and a novel surgical approach

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.

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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.

Key words: Superior mesenteric artery syndrome, Wilkie's syndrome, duodenal obstruction, laparoscopy, duodenojejunostomy, Strong's procedure

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