Our case report describes an 18-year-old female patient who presented to our clinic about 6 months ago with severe epigastric pain, nausea, heartburn, regurgitation, and weight loss (about 5 kg). Her epigastric pain had a colic nature and did not radiate to other parts of the abdomen, the regurgitation content included bile secretions, and there was no report of dysphagia. Moreover, she had no history of malignancy, trauma, burn, malabsorption, spinal cord injury, neurological diseases, or long-term hospitalization. No significant finding was reported in the physical examination except abdominal distention without any evidence of tenderness or hyperactive bowel sounds. The patients underwent endoscopy, revealing antral erythema and mild to moderate gastritis. Eventually, she was diagnosed with Helicobacter pylori infection using gastric biopsy and was prescribed a one-month course of antibiotic therapy.
However, there was no symptom alleviation. After one month, the patient presented to our clinic for the second time with the same symptoms. Therefore, she was rehospitalized and underwent abdominal and pelvic CT scan with IV contrast (Figures 1 and 2). According to the CT findings, the proximal part of the duodenum was dilated, and the angle between the aorta and SMA was about 8 degrees. A consultation with the surgery service was ordered for the patient to confirm the diagnosis of SMAS. Due to the severity of epigastric pain and severe reduction of the angle between the aorta and SMA, the patient was then transferred to the surgery ward and underwent laparoscopic duodenojejunostomy. Following abdominal insufflation, a laparoscope was introduced into the peritoneal cavity, which showed the dilation of the proximal duodenum. However, the jejunum seemed to be normal. Afterward, 3 additional trocars were placed. After retraction of the transverse colon, the Treitz ligament was identified, and SMA was noted to be prominent and lying across the distal duodenum, which was collapsed. A duodenojejunostomy was performed. Then, a side-to-side anastomosis was made. Moreover, the methylene blue test did not show any leakage. The patient responded to the surgery dramatically. Four days after the surgery, she could consume oral fluids and then start a regular diet.