Laparoscopic Duodenojejunostomy for Superior Mesenteric Artery Syndrome (13...

Patient was a 13-year-old male at the 50th percentile for weight given his age

CT scan demonstrated an obstruction at the third portion of the duodenum and a narrow aorta mesenteric angle

Patient failed to gain weight over a two-week period with ongoing high volume NG tube output despite conservative management with NG decompression and nasoduodenal feeds

Laparoscopic duodenojejunostomy was performed using an umbilical camera port, a right-sided retracting port, and two left-sided working ports

A transabdominal suture through the omentum was used to retract the transverse colon during the dissection

An anastomosis at the third portion of the duodenum has the benefits of leaving the transverse colon intact and avoids a duodenal diverticulum proximal to the mesenteric root

A jejunal loop approximately 30 centimeters distal to the ligament of Treitz was selected for the anastomosis

A 45 millimeter endoGIA stapler was used to create the anastomosis

The common enterotomy was closed with an absorbable suture in a single layer

Postoperatively, the patient underwent bowel rest for 5 days

A contrast study performed on postoperative day 5 demonstrated a patent anastomosis without leak

The patient was discharged 2 days after the contrast study following quick diet advancement