EP 300 Laparoscopic True Roux-en-Y Duodenojejunostomy for Superior Mesenteric Artery Syndrome
Mai Mohamed, Ricardo CamprodonAbstract
Aims
Superior mesenteric artery (SMA) syndrome is a rare cause of proximal intestinal obstruction resulting from compression of the third part of the duodenum between the aorta and the superior mesenteric artery. Duodenojejunostomy is an established surgical treatment following failure of conservative management. However, the term “Roux-en-Y duodenojejunostomy” is inconsistently applied in the literature and frequently used to describe simple loop reconstructions lacking a jejunojejunostomy. We report the use of a true Roux-en-Y duodenojejunostomy with two anastomoses and defined limb lengths and describe its physiological rationale in a malnourished patient.
Methods
A 22-year-old woman presented with a two-year history of progressive unintentional weight loss of 10kg, body mass index 16, postprandial nausea and vomiting, epigastric pain, early satiety, and bloating. Contrast-enhanced CT imaging confirmed SMA syndrome. Following failure of a six-month trial of conservative management, she underwent a laparoscopic retrocolic true Roux-en-Y duodenojejunostomy. Reconstruction consisted of a side-to-side duodenojejunostomy and a side-to-side jejunojejunostomy, creating a 30-cm Roux limb and a deliberately short 25-cm biliopancreatic limb.
Results
Postoperative recovery was uncomplicated. Oral intake was resumed on postoperative day three, and the patient was discharged on day six. At three-month follow-up, she reported complete symptom resolution with sustained weight gain of 3.5kg.
Conclusion
Laparoscopic true Roux-en-Y duodenojejunostomy with controlled limb lengths is a safe and effective surgical option for SMA syndrome following failed conservative therapy. The use of two anastomoses distinguishes this reconstruction from a simple loop duodenojejunostomy, while short limb lengths may prevent bile reflux without exacerbating malabsorption in malnourished patients.