Abstract
We have performed duodenojejunostomy for two cases of superior mesenteric artery syndrome of different etiologies.
The patient 1, a 66-year-old man, was seen at the hospital because of recurrent bouts of vomiting, abdominal pain, and weight loss since about 3 years earlier. An upper gastrointestinal series and an abdominal contrast enhanced CT scan showed severe gastric dilatation and narrowing at the third portion of the duodenum, and superior mesenteric artery syndrome was diagnosed. The patient was considered to be a candidate for operation because his ailing time was long, and was performed duodenojejunostomy. The patient's postoperative course was uneventful.
The patient 2 was a 77-year-old man who had undergone anterior resection of the rectum for rectal cancer about 30 years before admission. This time left colectomy was performed for transverse colon cancer. Vomiting occurred on the postoperative day 9. An upper gastrointestinal series and an abdominal CT scan provided the diagnosis of superior mesenteric artery syndrome. After unsuccessful conservative therapy, duonenojejunostomy was performed on the 21st postoperative day. The clinical course after the second operation was uneventful.
Etiologies of the disease in these patients appear to be different. In the patient 1, a decrease in periduodenal fatty tissues due to weight loss might cause the disease. In the patient 2, overextension of the superior mesenteric root due to left colectomy following anterior resection of the rectum might result in deviation of the superior mesenteric artery (SMA) toward the caudal direction.
