Superior Mesenteric Artery Syndrome After Roux-en-Y Gastric Bypass

BACKGROUND AND OBJECTIVES: As bariatric surgery becomes more widespread, atypical complications will be seen with more frequency. In this case series, we report on 3 cases of superior mesenteric artery syndrome after gastric bypass and the laparoscopic treatment. METHODS: This is a case series of 3 patients who presented with the persistent postprandial symptoms of pain and nausea after gastric bypass, and through an extensive workup were eventually diagnosed with superior mesenteric artery syndrome. All 3 patients had dramatic weight loss after laparoscopic Roux-en-y gastric bypasses. Gastric remnant distention was not a consistent finding, but persistent postprandial nausea, epigastric pain, and computed tomographic findings of a narrowed angle between the superior mesenteric artery and the aorta were consistently found. Two patients were treated with a laparoscopic gastroduodenal jejunostomy anastomosis, and one patient had a duodenojejunostomy, all with resolution of their symptoms. RESULTS: A laparoscopic gastroduodenal (or duodeno-) jejunal bypass was performed in each case, which resolved the obstruction caused by the superior mesenteric artery syndrome. CONCLUSIONS: Superior mesenteric artery syndrome can be caused by the dramatic weight loss induced by a gastric bypass. This post weight loss surgery phenomenon may be far more prevalent and underdiagnosed than reported, and should be considered in all patients with greater than average weight loss at one year and who have persistent postprandial nausea and epigastric pain. This can be successfully treated by bypassing the obstruction, while maintaining the weight loss induced by the Roux-en-y gastric bypass.