Laparoscopic revision of gastro-jejunostomyto duodenojejunostomy with roux-en-yjejunojejunostomy for persistent sma syndrome; a case report

Background: Superior Mesenteric Artery Syndrome (SMA syndrome) is a condition that occurs when the third part of the duodenum is compressed between the Aorta and the Superior Mesenteric Artery which causes postprandial abdominal pain, nausea, and vomiting due to partial or complete blockage of the duodenum. It is thought to be caused by rapid weight loss leading to sudden decrease in the angle between the Aorta and SMA which results in gastric outlet obstruction, failure to gain weight, and electrolyte disturbances. Case presentation: We report an original case of a previously diagnosed 35-year-old female with SMA syndrome through history and radiological findings who initially underwent gastrojejunostomy for the treatment of her SMA syndrome two years prior to her presentation without resolution of her gastric outlet obstruction symptoms. CT scan of the abdomen at the time of presentation revealed an aortomesenteric angle of 22 and distance of 8.5mm with an intact anastomosis of the gastrojejunostomy. Laparoscopic revision of gastro-jejunostomy followed by duodenojejunostomy with Roux-en-Y jejuenojejunostomy was successfully performed with resolution of the patient’s symptoms. Conclusion: Surgical intervention is the mainstay in cases of SMA syndrome refractory to conservative management. Gastrojejunostomy is not commonly preferred due to the high recurrence rate of symptoms. We report an original case of persistent SMA syndrome post gastrojejunostomy which was treated with laparoscopic revision of gastrojejunostomy followed by duodenojejunostomy with Roux-en-Y jejuenojejunostomy. No previous reports of this surgical intervention or similar presentations were found in the literature.