上腸間膜動脈性十二指腸閉塞症(SMA syndrome)に対する腹腔鏡下十二指腸空腸吻合術

Superior mesenteric artery (SMA) syndrome is a rare disorder, recognized as nausea, vomiting, weight loss, and postprandial abdominal pain due to compression and obstruction of the third portion of the duodenum by the SMA. If conservative treatment fails, then duodenojejunostomy or lysis of the ligament of Treitz is indicated. Recently, laparoscopic techniques have been described. This is the first case report, to our knowledge, of performance of a laparoscopic duodenojejunostomy for treatment of SMA syndrome in Japan. A 17-year-old female with a diagnosis of SMA syndrome was prepared for surgery after having failed conservative management. Laparoscopic duodenojejunostomy was performed through the mesenterium of the transverse colon. Postoperative course was uneventful. A gastografin study obtained on postoperative day 6 demonstrated no leakage of the anastomosis and free flow of contrast medium through the duodenojejunostomy. Laparoscopic duodenojejunostomy is safe and effective and a viable method for treatment of SMA syndrome.