Laparoscopic duodenal derotation due to superior mesenteric artery syndrome

Introduction: Wilkie’s Syndrome, also called the Superior Mesenteric Artery Syndrome (SMA) is a clinical entity characterized by compression of the 3rd portion of the duodenum between the aorta and the emergence of the SMA. It is a rare cause of duodenal obstruction with around 400 cases reported in the literature. Methods: this video illustrates the case of a 50 year-old patient with a history of ankylosing spondylitis and cholecystectomy by laparotomy. She was admitted at the Emergency Room with a story suggestive of high intestinal obstruction. During hospitalization, a CT-scan was performed suggesting the existence of a mesenteric clamp. This etiology was confirmed after evaluation of the abdomen with Magnetic Resonance Imaging the next day. Results: the patient was subjected to a laparoscopic duodenal derotation, with resolution of clinical symptoms. Conclusions: duodenal derotation can be sufficient to treat this pathology. The laparoscopic approach, when performed by an experienced laparoscopic surgeon and using the same principles of laparotomy, should be preferred. It allows a better visualization of anatomical structures and a better patient recovery.

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Laparoscopic   duodenal   derotation   due   to   superior   mesenteric   artery   syndrome

Authors
Abstract
Introduction: Wilkie’s Syndrome, also called the Superior Mesenteric Artery Syndrome (SMA) is a clinical entity characterized by compression of the 3rd portion of the duodenum between the aorta and the emergence of the SMA. It is a rare cause of duodenal obstruction with around 400 cases reported in the literature.
Methods: this video illustrates the case of a 50 year-old patient with a history of ankylosing spondylitis and cholecystectomy by laparotomy. She was admitted at the Emergency Room with a story suggestive of high intestinal obstruction. During hospitalization, a CT-scan was performed suggesting the existence of a mesenteric clamp. This etiology was confirmed after evaluation of the abdomen with Magnetic Resonance Imaging the next day.
Results: the patient was subjected to a laparoscopic duodenal derotation, with resolution of clinical symptoms.
Conclusions: duodenal derotation can be sufficient to treat this pathology. The laparoscopic approach, when performed by an experienced laparoscopic surgeon and using the same principles of laparotomy, should be preferred. It allows a better visualization of anatomical structures and a better patient recovery.
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06'57''
Publication
2012-01
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en
E-publication
WeBSurg.com, Jan 2012;12(01).
URL: http://www.websurg.com/doi-vd01en3549.htm

Laparoscopic   duodenal   derotation   due   to   superior   mesenteric   artery   syndrome