Bariatric surgery is the most effective and durable treatment for morbidly obese patients. However, there are remained unsolved problems with various types of complications. Superior mesenteric artery syndrome is a rarely known condition occurred following bariatric surgery. We experienced 54-year-old female patient diagnosed with superior mesenteric artery syndrome 5 year later after laparoscopic adjustable gastric banding. Because symptoms have not improved with conservative care, laparoscopic duodenojejunal bypass was successfully performed for this patient.
Bariatric Surgery ; Female ; Humans ; Mesenteric Artery, Superior ; Middle Aged ; Superior Mesenteric Artery Syndrome

The superior mesenteric artery (SMA) is one of the visceral branches of the abdominal aorta. It has multiple branches to supply blood and nutrition to the intestinal segment, and these form an anastomosis with each other. SMA injuries are usually classified as major visceral artery injuries, and have an incidence of <1%. The clinical manifestations of patients with SMA injuries include intra-abdominal bleeding and peritoneal irritation. The compromised blood supply can lead to intestinal ischemia and perforation. These injuries are often not diagnosed in time and have significant mortality rates of 25%‍-‍68% due to the lack of specific features (Maithel et al., 2020). Not only that, but patients with less severe trauma or no visible damage on initial examination may still have clinically significant intra-abdominal injuries (Nishijima et al., 2012). Emergency departments often encounter multiple cases that require urgent diagnosis and treatment (Li et al., 2021; Zhang et al., 2021; Zhou et al., 2021), and therefore, it is imperative to diagnose and manage these rare injuries expeditiously.
Humans ; Mesenteric Artery, Superior/surgery* ; Abdominal Injuries/diagnosis* ; Intestines

When abdominal neoplasms originating from the pancreas or nearby organs locally involving the superior mesenteric artery (SMA), complete resection is still the only hope for cure. However, SMA resection and reconstruction is a complex surgical procedure associated with high postoperative morbidity and mortality. Intestinal autotransplantation has recently emerged in clinical practice as a treatment option for selected patients with neoplasms involving the SMA. The original procedure involved en bloc removal of a tumor together with the intestine, ex vivo resection and reconstruction of gastrointestinal tract by an intestinal autograft. To further refine this complex procedure, a modified method was developed in which a segmental bowel autograft is selected and harvested first during the initial stage of the operation, and radical resection of the neoplasm is carried out thereafter. The modification would better protect a healthy bowel autograft from potential damage due to prolonged warm ischemia and allow the subsequent lengthy process of dissection to be performed in an unrushed manner. Furthermore, this alteration would better adhere to the general principles of minimal tumor manipulation during operation and potentially decrease the risks of tumor implantation during in vitro organ perfusion. Although intestinal autotransplantation has expanded eligibility for resection of otherwise unresectable lesions involving the SMA, its operative complexity, high risks, and post-operative complications largely limit its clinical applications.
Humans ; Intestines ; Mesenteric Artery, Superior/surgery* ; Pancreatic Neoplasms ; Transplantation, Autologous

BACKGROUNDHepatic artery variations are frequent clinical occurrences. The aim of this study was to investigate the characteristic course of variant hepatic arteries originating from the superior mesenteric artery for the purpose of providing instructions for abdominal tumor surgery.

METHODSThe course of variant hepatic arteries originating from the superior mesenteric artery was studied in 400 patients with liver cancer confirmed by digital subtraction angiography (DSA) and multi-slice spiral computed tomography angiography (MSCTA), and 86 patients with gastric cancer confirmed by preoperative MSCTA between June 2008 and June 2010 in the First Affiliated Hospital of Guangxi Medical University.

RESULTSHepatic artery variations originating from the superior mesenteric artery were noticed in 49 liver cancer patients and 14 gastric cancer patients (total 63 cases), with a variation rate of 12.96%, including two cases (3.17%) where the hepatic arteries ran along the anterior pancreas, and 61 cases (96.83%) where the hepatic arteries ran along the posterior pancreas.

CONCLUSIONSHepatic artery variations originating from the superior mesenteric artery present as two types: the pre-pancreas type and the post-pancreas type with the latter predominating. This finding is of clinical significance in abdominal tumor surgeries where clearance of portal lymph nodes is needed.

Hepatic Artery ; physiology ; Humans ; Liver Neoplasms ; surgery ; Mesenteric Artery, Superior ; physiology ; Middle Aged ; Stomach Neoplasms ; surgery

Angioplasty ; Embolectomy ; Ischemia ; pathology ; surgery ; Mesenteric Artery, Superior ; pathology ; surgery ; Mesenteric Ischemia ; Thrombosis ; pathology ; surgery ; Vascular Diseases ; pathology ; surgery

Adolescent ; Duodenum ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Superior Mesenteric Artery Syndrome ; surgery

Acute mesenteric ischemia after cardiac surgery is a serious complication associated with high mortality. Superior mesenteric artery is most commonly affected artery. Acute obstruction of mesenteric artery generally has an unfavorable prognosis because of late diagnosis. The keys to a successful outcome are early diagnosis and appropriate operative intervention. We successfully treated a patient with acute mesenteric ischemia after aortic valve replacement. Therefore, we report a case with a review of articles.
Aortic Valve* ; Arteries ; Delayed Diagnosis ; Early Diagnosis ; Humans ; Ischemia* ; Mesenteric Arteries ; Mesenteric Artery, Superior ; Mortality ; Prognosis ; Thoracic Surgery

OBJECTIVETo assess the value of MDCT with vessel probe(VP) in the diagnosis and treatment of isolated superior mesenteric artery dissection (ISMAD).

METHODSClinical and imaging data of 15 patients with ISMAD admitted to the First Affiliated Hospital of Sun Yat-Sen University from June 2008 to May 2013 were retrospectively reviewed. Relationship among radiograpic features, clinical symptoms and therapeutic options of ISMAD was examined based on the imaging of 64-MDCT with VP.

RESULTSThe dissection crevasse of all the 15 patients located in anterior arterial wall, and the distance was(24.3±9.7) mm from the origin of SMA. Meanwhile dissection crevasse of 73.3%(11/15) patients located in the zone within 1 cm of proximal end and 1 cm of distal end of the proximal SMA curvature. There were significant differences between patients without abdominal pain(8 cases) and those with abdominal pain(7 cases) in dissection length, minor diameter ratio of true lumen to false lumen, major diameter ratio of true lumen to false lumen(all P<0.01). According to classification of Yun, there were 5 patients of typeI( and 3 type II(a, whose conservative treatment were successful. In other 7 patients of type II(b, 3 patients received successful conservative treatment, and 4 patients had symptom remission after turning to interventional treatment or surgery.

CONCLUSIONS64-MDCT with VP can clearly depict the image manifestation of ISMAD, which provides evidence for the diagnosis and therapeutic options of ISMAD.

Abdominal Pain ; Humans ; Mesenteric Artery, Superior ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVETo improve the operative procedure of the left renal vein nutcracker syndrome.

METHODSTwo patients underwent transposition of the left renal vein in the treatment of the left renal vein nutcracker syndrome.

RESULTRenal ischemia, due to clamping of the renal artery, lasted 14 minutes and 13 minutes, respectively. The gross hematuria disappeared 1 day and 4 days respectively after surgery, and microhematuria ceased spontaneously 5 days and 7 days respectively after surgery. Transposition of the left renal vein effectively relieved the symptoms related to the left renal vein nutcracker syndrome. The patients had no recurrence of symptoms following up during 3 months.

CONCLUSIONTransposition of the left renal vein is a safe and effective surgical approach in the treatment of the left renal vein nutcracker syndrome.

Adult ; Constriction, Pathologic ; Hematuria ; prevention & control ; Humans ; Male ; Mesenteric Artery, Superior ; abnormalities ; Renal Veins ; surgery ; Syndrome

Superior mesenteric artery (SMA) syndrome is rare disorder, which is caused by a reduction in the aortomesenteric angle causing a duodenal obstruction. It is usually occurs after a period of weight loss, nausea, and vomiting by a partial obstruction of the third portion of the duodenum. If conservative management fails then a laparotomy with a duodenojejunostomy is indicated. Recently, a minimally invasive or laparoscopic approach to the retroperitoneum or duodenal detachment was introduced. Although the role of a laparoscopy in managing SMA syndrome is not clearly defined, a laparoscopic duodenojejunostomy may be an alternative approach to the surgical treatment of SMA syndrome cases. Two cases of superior mesenteric artery syndrome that were treated laparoscopically after medical therapy failure are described. The 4-port procedure was performed. A dilated bowel on the third portion of the duodenum was observed below the transverse mesocolon and to right of the superior mesenteric artery. A proximal loop of the jejunum was anastomosed to the duodenum using an endoscopic GIA stapler. The surgery time and hospital length of stay were acceptable. No complications were encountered in this study. A laparoscopic duodenojejunostomy is a feasible alternative option for treating SMA syndrome. It provides the benefits of being a definitive and minimally invasive surgical technique in a duodenal obstruction.
Adult ; *Duodenostomy ; Duodenum/radiography ; Female ; Human ; Jejunum/*surgery ; *Laparoscopy ; Male ; Superior Mesenteric Artery Syndrome/radiography/*surgery ; Tomography, X-Ray Computed