Two birds, one surgical stone: The first reported case of superior mesenteric artery syndrome secondary to biliary dyskinesia

Abstract

This is the first reported case of superior mesenteric artery syndrome secondary to biliary dyskinesia. SMA syndrome involves obstruction of the third portion of the duodenum, causing a gastric outlet obstruction due to narrowing of the space between the abdominal aorta and the superior mesenteric artery (SMA). Rapid weight loss has been shown to be a risk factor for this condition. We report a case found in a 14-year old Hispanic developmentally delayed female and review the literature. Our patient presented with a one-month history of abdominal pain, bilious emesis, and weight loss. She was seen at an outside facility where she had two abdominal operations without symptomatic relief. A HIDA scan performed at our facility was consistent with biliary dyskinesia, and an UGIS confirmed a concomitant SMA syndrome. An open cholecystectomy with a side-to-side duodenojejunostomy was performed. Postoperatively, patient continued with gastropareisis, requiring nutritional support via TPN and insertion of a jejunostomy tube. On post operative day 24, patient was discharged home tolerating full feeds. She has since been seen in follow up, and is doing well.

Keywords

• Biliary dyskinesia
• Superior mesenteric artery syndrome
• Duodenojejunostomy