Minimally invasive surgical management of superior mesenteric artery syndrome (SMAS) in children

Abstract

Purpose Superior mesenteric artery syndrome (SMAS) is a rare but potentially life-threatening disorder. It has a low incidence, and its clinical presentation can often mimic other disorders, making its diagnosis challenging. Methods Four patients treated from 2017–2023 presented with chronic abdominal pain, nausea, vomiting and severe weight loss, leading to malnutrition. Psychological evaluations were conducted to comprehensively assess their condition. Diagnostic tests included abdominal X-rays demonstrating gastric distension, upper gastrointestinal series revealing duodenal contrast retention, endoscopy indicating difficulty in advancing into the third portion of the duodenum and CT angiography demonstrating a decrease in the angle between the SMA and the abdominal aorta. Referral to pediatric surgery was necessary after conservative management yielded no improvement. Results In three patients, laparoscopic duodenojejunostomy was performed, whereas one patient underwent laparoscopic gastrojejunostomy. All patients were discharged with satisfactory recovery and no complications. Conclusions This study highlights the effectiveness and safety of laparoscopic surgical techniques in managing pediatric SMAS patients who are unresponsive to conservative measures. Laparoscopic duodenojejunostomy and gastrojejunostomy have demonstrated favorable outcomes in this context. Further research and data collection are warranted to continue evaluating the long-term success of these techniques in managing SMAS. Level of evidence IV, case series with no comparison group.