Diagnostics and surgical management children with superior mesenteric artery syndrome

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Abstract

BACKGROUND: Superior mesenteric artery syndrome causes chronic duodenal obstruction. Studies on this disease are limited; therefore, several difficulties in the diagnosis and treatment of such patients remain.

AIM: This study aimed to present the experience of treating children with superior mesenteric artery syndrome.

MATERIALS AND METHODS: The treatment results of 45 patients with superior mesenteric artery syndrome was retrospectively studied. The children complained of abdominal pain, nausea, occasional vomiting, belching, bloating, and constipation. The diagnosis was confirmed during a comprehensive examination, including ultrasound, esophagogastroduodenoscopy, X-ray contrast examination, computed tomography, and relaxation duodenography. Conservative therapy was performed in 38 (84,4%) children, and 21 (55,3%) children showed satisfactory results. In case of ineffectiveness of conservative measures (17 cases) or in a decompensated state (7 cases), indications for surgical treatment were provided.

Furthermore, 24 (53,3%) children underwent surgery. Duodenal drainage surgeries were performed in 20 (83,3%) patients with subcompensation of duodenostasis. Of these patients, 10 (41,7%) underwent lower duodenojejunostomy with a switched-off Roux-en-Y loop (Gregory–Smirnov’s operation) and the other 10 (41,7%) underwent anterior mesenteric duodenojejunostomy (Robinson’s operation). Laparotomic access was used in 14 cases (70,0%) and laparoscopic in 6 (30,0%) cases. Owing to decompensation of duodenostasis, the duodenum was excluded from passage by economical resection of the gastric outlet with gastrojejunostomy on a short loop with additional formation of a lower duodenojejunostomy according to Roux in 4 (16,7%) cases. Laparotomic access was used in all cases.

RESULTS: No intraoperative complications were noted. In the early postoperative period, two children developed anastomositis after Robinson’s operation and two patients after Gregory–Smirnov’s operation, which was treated with conservative measures. In long-term followup (up to 15 years), a satisfactory result was achieved in 87.5% of cases.

CONCLUSIONS: Superior mesenteric artery syndrome is a relatively rare cause of chronic duodenal obstruction in children. When selecting patients for surgical treatment, other diseases should be excluded. Surgical correction includes various options for duodenal drainage operations that can be successfully performed using laparoscopic access. In case of decompensation of duodenostasis, it may be crucial to exclude the duodenum from the passage.

About the authors

Yurii Yu. Sokolov

Russian Medical Academy of Continuous Professional Education

Email: sokolov-surg@yandex.ru
ORCID iD: 0000-0003-3831-768X
SPIN-code: 9674-1049

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Alaniia A. Gogichaeva

Russian Medical Academy of Continuous Professional Education; St. Vladimir Children’s Hospital

Author for correspondence.
Email: gogichalani@gmail.com
ORCID iD: 0000-0003-3614-6493
SPIN-code: 2124-5942
Russian Federation, Moscow; Moscow

Sergey A. Korovin

Russian Medical Academy of Continuous Professional Education; Children Hospital of Z.A. Bashlyaeva

Email: korovinsa@mail.ru
ORCID iD: 0000-0002-8030-9926
SPIN-code: 2091-6381

MD, Dr. Sci. (Medicine)

Russian Federation, Moscow; Moscow

Artem M. Efremenkov

Russian Medical Academy of Continuous Professional Education

Email: efremart@yandex.ru
ORCID iD: 0000-0002-5394-0165
SPIN-code: 6873-6732

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Roman A. Akhmatov

Russian Medical Academy of Continuous Professional Education; St. Vladimir Children’s Hospital

Email: romaahmatov@yandex.ru
ORCID iD: 0000-0002-5415-0499
SPIN-code: 9024-8324

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow; Moscow

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Supplementary files

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1. JATS XML
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2. Fig. 1. Lower duodenojejunostomy with a switched-off Roux-en-Y loop (Gregory–Smirnov’s operation)

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3. Fig. 2. Anterior mesenteric duodenojejunostomy (Robinson’s operation)

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4. Fig. 3. Antrectomy with gastroenteroanastomosis, supplemented by lower Roux-en-Y duodenojejunostomy with the formation of an anastomosis between the end-to-side jejunal loops leading from the gastroenteroanastomosis and duodenojejunostomy

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5. Fig. 4. Ultrasound examination: compressed duodenum between the aorta and superior mesenteric artery

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6. Fig. 5. Duodenoscopy: duodenum deformation in the form of a “gap”

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7. Fig. 6. Relaxation duodenography: vertical break of contrast of the lower horizontal branch of the duodenum to the right of the spine

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8. Fig. 7. Algorithm for diagnosis and treatment of children with superior mesenteric artery syndrome. УЗИ — ultrasound examination, ВБА — superior mesenteric artery; ЖКТ — gastrointestinal tract; ЭГДС — esophagogastroduodenoscopy; ДПК — duodenum; МСКТ — multislice computed tomography; ХДН — chronic duodenal obstruction

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