Two Cases of Superior Mesenteric Artery Syndrome after Y-Graft Replacement for Juxta-renal Abdominal Aortic Aneurysms

Abstract

We report two cases of superior mesenteric artery syndrome (SMAS) after Y-Graft replacement (Y-GR) for a juxta-renal abdominal aortic aneurysm (jAAA).

Case 1 was a 70-year-old man referred to our department for jAAA surgery (maximum jAAA diameter, 48 mm). Y-GR was performed and required clamping of the supra-renal aorta. At 10 postoperative days (POD) he vomited and developed potential postoperative ileus. Computed tomography (CT) and upper gastrointestinal fluoroscopy (UGF) revealed an expanded duodenum with severe stenosis of the horizontal portion. On the basis of the interposition of the stenotic duodenum between the superior mesenteric artery and the prosthesis overlap with the aneurysmal wall, he was diagnosed with SMAS. Although a gastrojejunal bypass operation was considered, his symptoms gradually improved and he was discharged at 39 POD. Case 2 was an 80-year-old man admitted to our institute for jAAA surgery (maximum diameter, 76 mm). The patient underwent Y-GR with clamping of the infra-renal aorta. He vomited at 8 POD. CT and UGF showed severe stenosis in the horizontal portion of the duodenum. He was diagnosed with SMAS based on similar findings to case 1. Following persistent conservative treatment (based on our experience from case 1), his symptoms gradually improved and he was discharged at 49 POD. These cases of postoperative SMAS may be related to surgical manipulation of tissue and organs around the supra-renal aorta and we can do conservative treatment for SMAS.