Laparoscopic Management of Superior Mesenteric Artery Syndrome

OBJECTIVES The differential diagnosis of intestinal obstruction includes mechanical obstruction, obstruction secondary to systemic disease, and idiopathic intestinal pseudo-obstruction. The causes of these are extensive; however, the majority of cases involve a mechanical cause. Superior mesenteric artery syndrome (SMAS) is a rare and controversial form of mechanical obstruction with just over 300 well-defined cases described in the literature. The diagnosis is often difficult to establish, even after surgery. In addition, this syndrome sometimes may be managed conservatively, leaving a definitive diagnosis unproven. We describe herein 2 patients with SMAS successfully treated with laparoscopic duodenojejunostomy. METHODS Two cases of SMAS occurred in young men ages 23 and 34. The workup included a consultation with a gastroenterologist, an upper gastrointestinal (GI) endoscopy, upper GI series with small bowel follow-through, computed tomography scan, ultrasound of the abdomen, and abdominal aortogram. This diagnosis was established after consultation with the surgeon and the gastroenterologist in each case. RESULTS Laparoscopic duodenojejunostomy was performed in each case, and both patients have had complete resolution of their preoperative symptoms. CONCLUSIONS A laparoscopic approach to the management of superior mesenteric artery syndrome is a reasonable and successful way of treating these patients.