A Case of Superior Mesenteric Artery Syndrome in a Young Patient Treated Laparoscopically with Double Tract Reconstruction

The patient was a 16-year-old boy who had suffered from vomiting and been treated conservatively by a local pediatrician for more than 3 years. He was referred to our department due to no improvement in the symptom. The angle and distance between the aorta and the superior mesenteric artery (SMA) were reduced to 13° and 5.6 mm, respectively, indicating SMA syndrome. Conservative treatment was continued at our department, but there was still no improvement and surgical treatment was considered unavoidable. From among various reported treatment options, we selected laparoscopic double tract reconstruction with the goals of a maximum therapeutic effect and an acceptable aesthetic outcome, given the young age of the patient. The procedure involved two anastomoses and thus the operative time was relatively long (205 minutes), but the whole procedure was completed under a laparoscopic view. The patient had an uneventful postoperative course and was discharged from hospital 10 days after surgery. The surgical technique used in this case is a viable treatment option for SMA syndrome because it can maintain the physiological pathway while keeping the advantages of duodenal transposition.