Laparoscopic duodenojejunostomy for the treatment of pediatric superior mesenteric artery syndrome: A case series

Background: Superior mesenteric artery syndrome (SMAS) presents with nausea, anorexia, and postprandial pain resulting from duodenal compression. Previous adult series have demonstrated that patients with symptoms refractory to medical treatment may benefit from a laparoscopic duodenojejunostomy (LDJ). The aim of this analysis is to present a series of pediatric patients treated with LDJ for SMAS. Methods: We reviewed all pediatric patients (age <21) who received a LDJ for SMAS at a quaternary care hospital from 2017 to 2022. Results: We identified 8 female patients who underwent LDJ for SMAS. Median age and BMI at surgery were 16 (IQR 14.8-17.3) and 19.8 kg/m(2) (IQR 19.1-20.6). The median aortomesenteric distance and SMA angle were 4.1 mm (IQR 3.03-5.75) and 14.7 degrees (IQR 12.4-17.3). Nasojejunal feeding was administered to 63 % (n = 5) of patients preoperatively. Concomitant gastrointestinal disease, psychiatric comorbidity, and connective tissue disorder was present in 63 % (n = 5), 38 % (n = 3), and 38 % (n = 3) of patients, respectively. Median hospital length of stay was 4 days (IQR 2.0-9.25). 63 % (n = 5) patients presented to the emergency department for gastrointestinal complaints at a median of 48 days postoperatively. One patient experienced a small bowel obstruction requiring reoperation. At follow-up, a median of 37 days, 75 % of patients reported improvement in symptoms. No patients required further nasojejunal or parenteral supplementation. Conclusion: SMAS is a complex disease entity that may appropriately be treated safely with LDJ in selected pediatric patients. The presence of comorbid conditions may contribute to the development of SMAS and complicate recovery in this population.