SMA SYNDROME WITH DUODENOJEJUNAL DIVERTICULOSIS. A VERY RARE COMBINATION CAUSING DUODENAL OBSTRUCTION

SMA syndrome is an unusual cause of proximal intestinal obstruction. It is a clinical entity characterized by compression of the third, or transverse, portion of the duodenum between the aorta and the superior mesenteric artery. This results in chronic, intermittent, or acute complete or partial duodenal obstruction. We present a case of 40 years old lady who presented with postprandial abdominal pain at the epigastric region, colic type, without radiation accompanied by nausea, postprandial vomiting and weight loss. She was evaluated and diagnosed as SMA syndrome with duoduenojejunal diverticulosis . She was taken up for surgery due to chronic malnutrition not improving with conservative management. Duodenojejunostomy with transgastric feeding jejunostomy was done . To alleviate postoperative refractive gastroparesis , kinking and angulation, transgastric feeding jejunostomy was done in contrast to modified witzels technique . The patient was free of symptoms and recurrence during follow up .