Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2015; 21(45): 12970-12975
Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12970
Minimally invasive surgery for superior mesenteric artery syndrome: A case report
Si-Yuan Yao, Ryuichi Mikami, Sakae Mikami
Si-Yuan Yao, Ryuichi Mikami, Department of Surgery, Kobe City Medical Center West Hospital, Nagata-ku, Kobe 653-0013, Japan
Sakae Mikami, Department of Gastroenterology, Kobe City Medical Center West Hospital, Nagata-ku, Kobe 653-0013, Japan
Author contributions: Yao SY, Mikami S and Mikami R contributed to the manuscript writing and revision.
Institutional review board statement: The study was reviewed and approved by the Kobe City Medical Center West Hospital Institutional Review Board.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Si-Yuan Yao, MD, Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagata-ku, Kobe 653-0013, Japan. siyuan@kobe-nishishimin-hospi.jp
Telephone: +81-78-5765251 Fax: +81-78-5765358
Received: April 13, 2015
Peer-review started: April 15, 2015
First decision: May 18, 2015
Revised: May 25, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: December 7, 2015
Abstract

Superior mesenteric artery (SMA) syndrome is defined as a compression of the third portion of the duodenum by the abdominal aorta and the overlying SMA. SMA syndrome associated with anorexia nervosa has been recognized, mainly among young female patients. The excessive weight loss owing to the eating disorder sometimes results in a reduced aorto-mesenteric angle and causes duodenal obstruction. Conservative treatment, including psychiatric and nutritional management, is recommended as initial therapy. If conservative treatment fails, surgery is often required. Currently, traditional open bypass surgery has been replaced by laparoscopic duodenojejunostomy as a curative surgical approach. However, single incision laparoscopic approach is rarely performed. A 20-year-old female patient with a diagnosis of anorexia nervosa and SMA syndrome was prepared for surgery after failed conservative management. As the patient had body image concerns, a single incision laparoscopic duodenojejunostomy was performed to achieve minimal scarring. As a result, good perioperative outcomes and cosmetic results were achieved. We show the first case of a young patient with SMA syndrome who was successfully treated by single incision laparoscopic duodenojejunostomy. This minimal invasive surgery would be beneficial for other patients with SMA syndrome associated with anorexia nervosa, in terms of both surgical and cosmetic outcomes.

Keywords: Superior mesenteric artery syndrome, Anorexia nervosa, Young female patient, Single incision laparoscopic duodenojejunostomy, Minimally invasive surgery

Core tip: Traditional open bypass surgery has been replaced by laparoscopic duodenojejunostomy as a curative surgical approach for superior mesenteric artery (SMA) syndrome. However, the single incision laparoscopic approach is rarely performed. Here, we show our experience of single incision laparoscopic duodenojejunostomy in a 20-year-old woman with anorexia nervosa and SMA syndrome. As both diseases are commonly seen in young women with body image concerns, the cosmetic outcome of surgery should be taken into consideration. We believe that this minimally invasive surgery is beneficial for patients with SMA syndrome associated with body image concerns, in terms of both surgical and cosmetic outcomes.