Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12970
Peer-review started: April 15, 2015
First decision: May 18, 2015
Revised: May 25, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: December 7, 2015
Processing time: 237 Days and 3 Hours
Superior mesenteric artery (SMA) syndrome is defined as a compression of the third portion of the duodenum by the abdominal aorta and the overlying SMA. SMA syndrome associated with anorexia nervosa has been recognized, mainly among young female patients. The excessive weight loss owing to the eating disorder sometimes results in a reduced aorto-mesenteric angle and causes duodenal obstruction. Conservative treatment, including psychiatric and nutritional management, is recommended as initial therapy. If conservative treatment fails, surgery is often required. Currently, traditional open bypass surgery has been replaced by laparoscopic duodenojejunostomy as a curative surgical approach. However, single incision laparoscopic approach is rarely performed. A 20-year-old female patient with a diagnosis of anorexia nervosa and SMA syndrome was prepared for surgery after failed conservative management. As the patient had body image concerns, a single incision laparoscopic duodenojejunostomy was performed to achieve minimal scarring. As a result, good perioperative outcomes and cosmetic results were achieved. We show the first case of a young patient with SMA syndrome who was successfully treated by single incision laparoscopic duodenojejunostomy. This minimal invasive surgery would be beneficial for other patients with SMA syndrome associated with anorexia nervosa, in terms of both surgical and cosmetic outcomes.
Core tip: Traditional open bypass surgery has been replaced by laparoscopic duodenojejunostomy as a curative surgical approach for superior mesenteric artery (SMA) syndrome. However, the single incision laparoscopic approach is rarely performed. Here, we show our experience of single incision laparoscopic duodenojejunostomy in a 20-year-old woman with anorexia nervosa and SMA syndrome. As both diseases are commonly seen in young women with body image concerns, the cosmetic outcome of surgery should be taken into consideration. We believe that this minimally invasive surgery is beneficial for patients with SMA syndrome associated with body image concerns, in terms of both surgical and cosmetic outcomes.