Laparoscopic Roux-en-Y Duodenojejunostomy for Duodenal Obstruction after Endovascular Aneurysm Repair Mimicking Superior Mesenteric Artery Syndrome: A Case Report.

introductionSuperior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction, typically associated with weight loss-related narrowing of the aortomesenteric angle. In contrast, fixed mechanical compression after endovascular aneurysm repair (EVAR) may produce duodenal obstruction that mimics SMA syndrome through a different mechanism. CASE PRESENTATION: A 79-year-old man developed recurrent postprandial abdominal pain and vomiting 4 years after EVAR. CT performed during symptomatic episodes showed marked compression of the horizontal duodenum by the aneurysm sac, whereas the aortomesenteric angle and distance were preserved during asymptomatic periods. Based on these findings, the patient was diagnosed with a duodenal obstruction after EVAR mimicking SMA syndrome. Because conservative treatment was ineffective, a laparoscopic duodenojejunostomy with Roux-en-Y reconstruction was performed to bypass the obstruction and prevent blind loop formation. The postoperative course was uneventful, and no symptom recurrence or complications were observed during 2 years of follow-up.

conclusionsLaparoscopic duodenojejunostomy with Roux-en-Y reconstruction may be a safe and effective treatment option for SMA syndrome-like duodenal obstruction caused by EVAR.