Diagnostics and surgical management children with superior mesenteric artery syndrome

Abstract

BACKGROUND: Superior mesenteric artery syndrome causes chronic duodenal obstruction. Studies on this disease are limited; therefore, several difficulties in the diagnosis and treatment of such patients remain.

AIM: This study aimed to present the experience of treating children with superior mesenteric artery syndrome.

MATERIALS AND METHODS: The treatment results of 45 patients with superior mesenteric artery syndrome was retrospectively studied. The children complained of abdominal pain, nausea, occasional vomiting, belching, bloating, and constipation. The diagnosis was confirmed during a comprehensive examination, including ultrasound, esophagogastroduodenoscopy, X-ray contrast examination, computed tomography, and relaxation duodenography. Conservative therapy was performed in 38 (84,4%) children, and 21 (55,3%) children showed satisfactory results. In case of ineffectiveness of conservative measures (17 cases) or in a decompensated state (7 cases), indications for surgical treatment were provided.

Furthermore, 24 (53,3%) children underwent surgery. Duodenal drainage surgeries were performed in 20 (83,3%) patients with subcompensation of duodenostasis. Of these patients, 10 (41,7%) underwent lower duodenojejunostomy with a switched-off Roux-en-Y loop (Gregory–Smirnov’s operation) and the other 10 (41,7%) underwent anterior mesenteric duodenojejunostomy (Robinson’s operation). Laparotomic access was used in 14 cases (70,0%) and laparoscopic in 6 (30,0%) cases. Owing to decompensation of duodenostasis, the duodenum was excluded from passage by economical resection of the gastric outlet with gastrojejunostomy on a short loop with additional formation of a lower duodenojejunostomy according to Roux in 4 (16,7%) cases. Laparotomic access was used in all cases.

RESULTS: No intraoperative complications were noted. In the early postoperative period, two children developed anastomositis after Robinson’s operation and two patients after Gregory–Smirnov’s operation, which was treated with conservative measures. In long-term followup (up to 15 years), a satisfactory result was achieved in 87.5% of cases.

CONCLUSIONS: Superior mesenteric artery syndrome is a relatively rare cause of chronic duodenal obstruction in children. When selecting patients for surgical treatment, other diseases should be excluded. Surgical correction includes various options for duodenal drainage operations that can be successfully performed using laparoscopic access. In case of decompensation of duodenostasis, it may be crucial to exclude the duodenum from the passage.

Keywords

arteriomesenteric duodenal compression / superior mesenteric artery syndrome / chronic duodenal obstruction / duodenum / children / laparoscopy

References

[1] Waheed KB, Shah WJ, Jamal A, et al. Superior mesenteric artery syndrome: An often overlooked cause of abdominal pain! Saudi Med J. 2021;42(10):1145–1148. doi: 10.15537/smj.2021.42.10.20210509

[2] Waheed K.B., Shah W.J., Jamal A., et al. Superior mesenteric artery syndrome: An often overlooked cause of abdominal pain! // Saudi Med J. 2021. Vol. 42, N. 10. P. 1145–1148. doi: 10.15537/smj.2021.42.10.20210509

[3] Waheed KB, Shah WJ, Jamal A, et al. Superior mesenteric artery syndrome: An often overlooked cause of abdominal pain! Saudi Med J. 2021;42(10):1145–1148. doi: 10.15537/smj.2021.42.10.20210509

[4] Dekonenko C, Hill JA, Sobrino JA, et al. Ligament of treitz release with duodenal lowering for pediatric superior mesenteric artery syndrome. J Surg Res. 2020;254:91–95. doi: 10.1016/j.jss.2020.04.006

[5] Dekonenko C., Hill J.A., Sobrino J.A., et al. Ligament of treitz release with duodenal lowering for pediatric superior mesenteric artery syndrome // J Surg Res. 2020. Vol. 254. P. 91–95. doi: 10.1016/j.jss.2020.04.006

[6] Dekonenko C, Hill JA, Sobrino JA, et al. Ligament of treitz release with duodenal lowering for pediatric superior mesenteric artery syndrome. J Surg Res. 2020;254:91–95. doi: 10.1016/j.jss.2020.04.006

[7] Chang J, Boules M, Rodriguez J, et al. Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome: intermediate follow-up results and a review of the literature. Surg Endosc. 2017;31(3):1180–1185. doi: 10.1007/s00464-016-5088-2

[8] Chang J., Boules M., Rodriguez J., et al. Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome: intermediate follow-up results and a review of the literature // Surg Endosc. 2017. Vol. 31, N. 3. P. 1180–1185. doi: 10.1007/s00464-016-5088-2

[9] Chang J, Boules M, Rodriguez J, et al. Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome: intermediate follow-up results and a review of the literature. Surg Endosc. 2017;31(3):1180–1185. doi: 10.1007/s00464-016-5088-2

[10] Ehlers T-O, Tsamalaidze L, Pereira L, Stauffer J. Laparoscopic duodenojejunostomy for the SMA Syndrome. Zentralbl Chir. 2018;143(5):461–463. doi: 10.1055/a-0668-1991

[11] Ehlers T.-O., Tsamalaidze L., Pereira L., Stauffer J. Laparoscopic duodenojejunostomy for the SMA Syndrome // Zentralbl Chir. 2018. Vol. 143, N. 5. P. 461–463. doi: 10.1055/a-0668-1991

[12] Ehlers T-O, Tsamalaidze L, Pereira L, Stauffer J. Laparoscopic duodenojejunostomy for the SMA Syndrome. Zentralbl Chir. 2018;143(5):461–463. doi: 10.1055/a-0668-1991

[13] Valiathan G, Wani M, Lanker J, Reddy PK. A case series on superior mesenteric artery syndrome surgical management, single institution experience. J Clin Diagn Res. 2017;11(8):PR01–PR03. doi: 10.7860/JCDR/2017/20248.10402

[14] Valiathan G., Wani M., Lanker J., Reddy P.K. A case series on superior mesenteric artery syndrome surgical management, single institution experience // J Clin Diagn Res. 2017. Vol. 11, N. 8. P. PR01–PR03. doi: 10.7860/JCDR/2017/20248.10402

[15] Valiathan G, Wani M, Lanker J, Reddy PK. A case series on superior mesenteric artery syndrome surgical management, single institution experience. J Clin Diagn Res. 2017;11(8):PR01–PR03. doi: 10.7860/JCDR/2017/20248.10402

[16] Ganss A, Rampado S, Savarino E, Bardini R. Superior mesenteric artery syndrome: A prospective study in a single institution. J Gastrointest Surg. 2019;23(5):997–1005. doi: 10.1007/s11605-018-3984-6

[17] Ganss A., Rampado S., Savarino E., Bardini R. Superior mesenteric artery syndrome: A prospective study in a single institution // J Gastrointest Surg. 2019. Vol. 23, N. 5. P. 997–1005. doi: 10.1007/s11605-018-3984-6

[18] Ganss A, Rampado S, Savarino E, Bardini R. Superior mesenteric artery syndrome: A prospective study in a single institution. J Gastrointest Surg. 2019;23(5):997–1005. doi: 10.1007/s11605-018-3984-6

[19] Da Costa KM, Saxena AK. Laparoscopic options in superior mesenteric artery syndrome in children: systematic review. J Ped Endosc Surg. 2019;1:53–57. doi: 10.1007/s42804-019-00013-0

[20] Da Costa K.M., Saxena A.K. Laparoscopic options in superior mesenteric artery syndrome in children: systematic review // J Ped Endosc Surg. 2019. Vol. 1. P. 53–57. doi: 10.1007/s42804-019-00013-0

[21] Da Costa KM, Saxena AK. Laparoscopic options in superior mesenteric artery syndrome in children: systematic review. J Ped Endosc Surg. 2019;1:53–57. doi: 10.1007/s42804-019-00013-0

[22] Oka A, Awoniyi M, Hasegawa N, et al. Superior mesenteric artery syndrome: Diagnosis and management. World J Clin Cases. 2023;11(15):3369–3384. doi: 10.12998/wjcc.v11.i15.3369

[23] Oka A., Awoniyi M., Hasegawa N., et al. Superior mesenteric artery syndrome: Diagnosis and management // World J Clin Cases. 2023. Vol. 11, N. 15. P. 3369–3384. doi: 10.12998/wjcc.v11.i15.3369

[24] Oka A, Awoniyi M, Hasegawa N, et al. Superior mesenteric artery syndrome: Diagnosis and management. World J Clin Cases. 2023;11(15):3369–3384. doi: 10.12998/wjcc.v11.i15.3369

[25] Repin VN, Repin MV, Efimova NS. Arteriomesenteric compression of duodenum-peristal colon. Perm: I. Maksarov Publ., 2009. 232 p. (In Russ.)

[26] Репин В.Н., Репин М.В., Ефимова Н.С. Артериомезентериальная компрессия двенадцатиперстной кишки. Пермь: Издательство И. Максарова, 2009. 232 с.

[27] Repin VN, Repin MV, Efimova NS. Arteriomesenteric compression of duodenum-peristal colon. Perm: I. Maksarov Publ., 2009. 232 p. (In Russ.)

[28] Arthurs OJ, Mehta U, Set PAK. Nutcracker and SMA syndromes: What is the normal SMA angle in children? Eur J Radiol. 2012;81(8):e854–e861. doi: 10.1016/j.ejrad.2012.04.010

[29] Arthurs O.J., Mehta U., Set P.A.K. Nutcracker and SMA syndromes: What is the normal SMA angle in children? // Eur J Radiol. 2012. Vol. 81, N. 8. P. e854–e861. doi: 10.1016/j.ejrad.2012.04.010

[30] Arthurs OJ, Mehta U, Set PAK. Nutcracker and SMA syndromes: What is the normal SMA angle in children? Eur J Radiol. 2012;81(8):e854–e861. doi: 10.1016/j.ejrad.2012.04.010

[31] Jonas JP, Rössler F, Ghafoor S, et al. Surgical therapy of celiac axis and superior mesenteric artery syndrome. Langenbecks Arch Surg. 2023;408(1):59. doi: 10.1007/s00423-023-02803-w

[32] Jonas J.P., Rössler F., Ghafoor S., et al. Surgical therapy of celiac axis and superior mesenteric artery syndrome // Langenbecks Arch Surg. 2023. Vol. 408, N. 1. ID 59. doi: 10.1007/s00423-023-02803-w

[33] Jonas JP, Rössler F, Ghafoor S, et al. Surgical therapy of celiac axis and superior mesenteric artery syndrome. Langenbecks Arch Surg. 2023;408(1):59. doi: 10.1007/s00423-023-02803-w

[34] Kubo T, Adachi Y, Kikuchi T, et al. Percutaneous endoscopic gastrojejunostomy for treating superior mesenteric artery syndrome. Gastrointest Endosc. 2019;90(6):983–984. doi: 10.1016/j.gie.2019.07.001

[35] Kubo T., Adachi Y., Kikuchi T., et al. Percutaneous endoscopic gastrojejunostomy for treating superior mesenteric artery syndrome // Gastrointest Endosc. 2019. Vol. 90, N. 6. P. 983–984. doi: 10.1016/j.gie.2019.07.001

[36] Kubo T, Adachi Y, Kikuchi T, et al. Percutaneous endoscopic gastrojejunostomy for treating superior mesenteric artery syndrome. Gastrointest Endosc. 2019;90(6):983–984. doi: 10.1016/j.gie.2019.07.001

[37] Shin MS, Kim JY. Optimal duration of medical treatment in superior mesenteric artery syndrome in children. J Korean Med Sci. 2013;28(8):1220–1225. doi: 10.3346/jkms.2013.28.8.1220

[38] Shin M.S., Kim J.Y. Optimal duration of medical treatment in superior mesenteric artery syndrome in children // J Korean Med Sci. 2013. Vol. 28, N. 8. P. 1220–1225. doi: 10.3346/jkms.2013.28.8.1220

[39] Shin MS, Kim JY. Optimal duration of medical treatment in superior mesenteric artery syndrome in children. J Korean Med Sci. 2013;28(8):1220–1225. doi: 10.3346/jkms.2013.28.8.1220

[40] Bing L, Shun-Lin X, Ji-Hua O, et al. Laparascopic Ladd’s procedure as treatment alternative, when parenteral or prolonged hospital nutrition is not an option for superior mesenteric artery syndrome. J Pediatr Surg. 2020;55(3):554–557. doi: 10.1016/j.jpedsurg.2017.07.004

[41] Bing L., Shun-Lin X., Ji-Hua O., et al. Laparascopic Ladd’s procedure as treatment alternative, when parenteral or prolonged hospital nutrition is not an option for superior mesenteric artery syndrome // J Pediatr Surg. 2020. Vol. 55, N. 3. P. 554–557. doi: 10.1016/j.jpedsurg.2017.07.004

[42] Bing L, Shun-Lin X, Ji-Hua O, et al. Laparascopic Ladd’s procedure as treatment alternative, when parenteral or prolonged hospital nutrition is not an option for superior mesenteric artery syndrome. J Pediatr Surg. 2020;55(3):554–557. doi: 10.1016/j.jpedsurg.2017.07.004

[43] Tang J, Zhang M, Zhou Y, et al. Laparoscopic lateral duodenojejunostomy for pediatric superior mesenteric artery compression syndrome: a cohort retrospective study. BMC Surg. 2023;23(1):365. doi: 10.1186/s12893-023-02274-2

[44] Tang J., Zhang M., Zhou Y., et al. Laparoscopic lateral duodenojejunostomy for pediatric superior mesenteric artery compression syndrome: a cohort retrospective study // BMC Surg. 2023. Vol. 23, N. 1. ID 365. doi: 10.1186/s12893-023-02274-2

[45] Tang J, Zhang M, Zhou Y, et al. Laparoscopic lateral duodenojejunostomy for pediatric superior mesenteric artery compression syndrome: a cohort retrospective study. BMC Surg. 2023;23(1):365. doi: 10.1186/s12893-023-02274-2

[46] Kirby GC, Faulconer ER, Robinson SJ, et al. Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice. Ann R Coll Surg Engl. 2017;99(6):472–475. doi: 10.1308/rcsann.2017.0063

[47] Kirby G.C., Faulconer E.R., Robinson S.J., et al. Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice // Ann R Coll Surg Engl. 2017. Vol. 99, N. 6. P. 472–475. doi: 10.1308/rcsann.2017.0063

[48] Kirby GC, Faulconer ER, Robinson SJ, et al. Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice. Ann R Coll Surg Engl. 2017;99(6):472–475. doi: 10.1308/rcsann.2017.0063

[49] Konstantinidis H, Charisis C, Kottos P. Robotic Strong’s procedure for the treatment of superior mesenteric artery syndrome. Description of surgical technique on occasion of the first reported case in the literature. Int J Med Robot. 2018;14(1):e1876. doi: 10.1002/rcs.1876

[50] Konstantinidis H., Charisis C., Kottos P. Robotic Strong’s procedure for the treatment of superior mesenteric artery syndrome. Description of surgical technique on occasion of the first reported case in the literature // Int J Med Robot. 2018. Vol. 14, N. 1. P. e1876. doi: 10.1002/rcs.1876

[51] Konstantinidis H, Charisis C, Kottos P. Robotic Strong’s procedure for the treatment of superior mesenteric artery syndrome. Description of surgical technique on occasion of the first reported case in the literature. Int J Med Robot. 2018;14(1):e1876. doi: 10.1002/rcs.1876

[52] Studenikin LV. Chronic duodenal patency abnormalities: modern view on the problem. Perm medical journal. 2017;34(6):101–109. EDN: YLAUYQ doi: 10.17816/pmj346101-109

[53] Студеникин Л.В. Хронические нарушения дуоденальной проходимости: современный взгляд на проблему // Пермский медицинский журнал. 2017. Т. 34, № 6. С. 101–109. EDN: YLAUYQ doi: 10.17816/pmj346101-109

[54] Studenikin LV. Chronic duodenal patency abnormalities: modern view on the problem. Perm medical journal. 2017;34(6):101–109. EDN: YLAUYQ doi: 10.17816/pmj346101-109

[55] Jain N, Chopde A, Soni B, et al. SMA syndrome: management perspective with laparoscopic duodenojejunostomy and long-term results. Surg Endosc. 2021;35(5):2029–2038. doi: 10.1007/s00464-020-07598-1

[56] Jain N., Chopde A., Soni B., et al. SMA syndrome: management perspective with laparoscopic duodenojejunostomy and long-term results // Surg Endosc. 2021. Vol. 35, N. 5. P. 2029–2038. doi: 10.1007/s00464-020-07598-1

[57] Jain N, Chopde A, Soni B, et al. SMA syndrome: management perspective with laparoscopic duodenojejunostomy and long-term results. Surg Endosc. 2021;35(5):2029–2038. doi: 10.1007/s00464-020-07598-1

RIGHTS & PERMISSIONS

Eco-Vector