Abstract
Superior mesenteric artery syndrome (SMAS) is a rare condition characterized by recurrent vomiting, abdominal distention, weight loss, and postprandial distress. The cause is compression of the duodenum between vessels and the vertebrae and paravertebrae muscles when the angle between the superior mesenteric vessels and the aorta is lower than 18°. The diagnosis is difficult and usually is made by exclusion. Conservative management is helpful at first; however, symptom recurrence would indicate surgical treatment. We recently treated a patient with SMAS. After extraction of a stomach bezoar by laparotomy, an upper gastrointestinal series suggested duodenal distention and a filling defect in the region of the superior mesenteric artery. Repeated ultrasonographic and abdominal CT scans showed a lateral pulsatile compression in the region of the distal duodenum, and SMAS was the diagnosis. Laparoscopic severing of Treitz's ligament was performed. The operation was successful, recovery was uneventful, and the patient has been asymptomatic for 1 year. The weight loss seen preoperatively has been corrected. We conclude that the laparoscopic division of the ligament of Treitz with a 5-mm instrument is a safe and efficient way to free the duodenum and move the duodenojejunal flexure downward. In our opinion, this procedure is the treatment of choice for this condition.
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