Transverse Portion Research Articles

805. BOCHDALEK HERNIA - CASE REPORT

Abstract Introduction Bochdalek hernia is a rare type of diaphragmatic hernia congenital and is quite uncommon in adulthood, representing only 0.17-6% of all diaphragmatic hernias. The objective of the present study is to report the technique surgery performed on a patient with a bochdalek hernia. Methods The information was obtained through medical record review, interview with the patient and literature review. Results/Discussion A 49-year-old female patient was admitted to a hospital in Natal (RN- Brazil) with vomiting for seven months, average of 3-4 vomits daily after meals, associated with dysphagia, epigastric pain and weight loss of 26 kg during this period. The physical examination, she was dehydrated, emaciated and with a flaccid abdomen and painless. Laboratory exams, she presented high levels of ureia and hypokalemia. CT scan of the chest and abdomen with contrast showed a hernia right posterolateral diaphragm with insinuation of the transverse colon and portion distal part of the stomach, in addition to significant gastric stasis, without signs of ischemia. Vigorous hydration was carried out and fasting was maintained, in addition, was inserted nasogastric tube and began parenteral nutrition. After ten days of parenteral nutrition and correction of hydro electrolyte disorders, there was an improvement in symptoms with laboratory normalization. So, she undergo a surgical intervention by videolaparoscopy. Surgical intervention took place with the pneumoperitoneum with Veress needle and trocars inserted (2 10-inch trocars). mm and 3 of 5 mm). Introduction of 30° optics. Cavity inventory identified massive right posterolateral diaphragmatic hernia, containing transverse colon and part of the stomach. Hepatic retractor was positioned to retracted the right hepatic lobe. Completely reduced the hernia through the Bochdalek foramen, after undoing content adhesions with the diaphragm. Afterwards, the closing of the defect with 2-0 Ethibond thread and a biocompatible mesh placed over the suture (Phasix) 10x10 cm and fixed with the same thread in separate stitches. Left drain blake type number 24 Fr, was left in the right hemithorax. The procedure was done uneventful. Conclusions Bochdalek hernia is a structural defect in the diaphragm, which can cause the passage of practically any intra-abdominal organ to the chest. Surgical repair of the defect is the only existing treatment option. In this case, we have a late presentation and in a complicated form. We opted for clinical stabilization of the patient, with nutrition and timely videolaparoscopy on the tenth day of hospitalization. The correction of hernia laparoscopically allows wide access to the workplace and with good mobility for dissection of the hernial sac, in addition to unquestionable acceleration of postoperative recovery and reduction of surgical trauma and size of the incisions. This way, we have a shorter hospitalization time with early return to the patient's daily activities.

Reconstruction of Chronic Soft Tissue Mallet Fingers: Outcomes of Step-Plasty vs. Purse-String Suture.

After failed conservative therapy or in the absence of any intervention, a rupture of the digital subcutaneous extensor tendon at the distal interphalangeal (DIP) joint, known as mallet finger, may lead to a chronic extension deficit due to excessive scarring and tendon elongation. Various surgical techniques to restore the extension of the distal phalanx have been proposed, but an optimal approach has not yet been established. To tighten the extensor tendon, a purse-string suture can be applied. Although it has shown efficacy, it can result in significant bulging and scar formation. Using the "abbreviato" technique, the elongated part of the extensor tendon is excised, and the tendon is re-sutured. Also, tenodesis has been described, particularly in pediatric cases. In this retrospective follow-up study, we aimed to investigate if the step-plasty procedure previously described by Baumeister provides comparable, if not superior, functional and aesthetic outcomes compared to existing techniques for patients with chronic mallet finger. In this retrospective study, a consecutive series of 68 patients with chronic mallet fingers was enrolled. Patients were treated surgically using step-plasty of the respective extensor tendon. After skin incision and tenolysis, the elongated extensor tendon was incised in a Z-like fashion and stepwise resected in the transverse portion of the Z. The functional and aesthetic effects of this step-plasty technique were compared with results of 44 patients previously treated using purse-string sutures of the extensor tendon and evaluated using Crawford's and Levante's criteria. In all patients undergoing the step-plasty procedure, the extension deficit was significantly reduced from an average of 42 degrees preoperatively to 11 degrees postoperatively. In contrast, the control group treated by purse-string sutures showed a slightly higher postoperative extension deficit of 15 degrees. According to Levante's criteria, the results of our step-plasty procedure were significantly better than those achieved with purse-string sutures. Our study demonstrated that the treatment of older or chronic subcutaneous extensor tendon ruptures using the step-plasty technique led to a significant reduction in extension deficits. According to Levante's criteria, the postoperative outcome was significantly better in comparison to the purse-string suture technique. Additionally, no skin resection was required to improve the extension capability of the distal finger joint, compared to established surgical procedures.

A Hidden Gastro-Vascular Etiology of Abdominal Pain; A Case Report of Cast Syndrome

Superior mesenteric artery (SMA) syndrome or Cast syndrome is an uncommon clinical entity characterized by compression of the transverse portion of the duodenum between the aorta and the superior mesenteric artery. This condition typically affects the population with age ranges from 10 to 30 years, and the incidence varies from 0.1% to 0.3%.

Nose Reconstruction Using Bilobed Flap: A Case Report

This document illustrates the formatting process for authors, who would be preparing their papers for publication in the International Journal of Scientific Advances (IJSCIA). It behooves the prospective authors the skillset, scientific or scholarly acumen and wherewithal to ensure that their manuscript contents are original and have never been submitted to other journals while under review in the IJSCIA. Background: Basal cell carcinoma (BCC) is a slow-growing, locally destructive malignant skin tumor. The nasal location is considered a high-risk feature of BCC because of its anatomical features and problems in identifying the tumor preoperatively. Surgery is the cornerstone of nasal BCC treatment and various techniques have been developed to combine full 3D tumor removal with good aesthetic and functional results. Case Presentation: We report a circular black discoloration of a 64-year-old male patient on the left side of the nose within 2 years. The patient was scheduled for surgical removal and reconstruction of the defect using a bilobed flap. The flap consists of two lobes with a common semicircular base marked around the transverse portion of the nasalis muscle and its aponeurosis. The flap then removes the skin from the triangular peninsula at the base of the defect. After removal, the flap is moved into the defect and placed with 5-0 Prolene with a simple suture. Conclusion: The bilobed flap has multipurpose in all ways. The main benefit of this flap include the similarity color and texture relative to the defect site, ease of reproducibility, low complication rates, and the ability to design it in different sizes and tissue compositions.

Rare Portal Venous Anomaly in a Living Liver Donor: A Case Report

Knowledge of the anatomy of the portal system is essential for safe liver resection. We report a very rare anatomic anomaly of the portal system in a living liver donor. A 24-year-old female living liver donor was found to have anomalies of the portal system on preoperative contrast-enhanced computed tomography. The ventral branch of the right anterior segment arose from the transverse portion of the left portal vein. The gallbladder and round ligament were positioned normally. Intraoperative cholangiography for evaluation of biliary anatomy revealed very low confluence of the right and left hepatic ducts. All the bile ducts from the right lobe merged into the right hepatic duct. A right lobe graft was performed, including the ventral area of the right anterior segment. The portal branch of the ventral area of the right anterior segment could be transected extrahepatically. In the recipient operation, each of the right main portal branches, including the right posterior segment branch and the dorsal branch of the right anterior segment, and the ventral branch of the right anterior segment, were anastomosed to the right and left branches of the portal vein, respectively, of the recipient. The transected right hepatic duct of the graft was anastomosed with the recipient's common hepatic duct. Sixteen years after the liver transplant, the recipient continues to do well and has good portal flow.

First record of tiger beetles (Coleoptera, Cicindelidae) from Rovno amber, with the description of a new genus and species.

A new fossil tiger beetle species, Goriresina fungifora gen. n., sp. n. (Coleoptera, Cicindelidae), is described from Eocene Rovno amber. The new genus belongs to the subtribe Iresiina, tribe Cicindelini, due to the glabrous head, the labrum with six submarginal setae (latero-basal setae very long) and two apical teeth with notch between them, the glabrous and globular pronotum, the lack of setae on the metepisternum and metepimeron, as well as on the visible parts of abdominal sternites, the single long seta each on the fore- and mesotrochanter. The new species is characterized by the long and moderately convex labrum, two clypeal setae, the elongate and apicad converging elytra with an angularly, but smoothly rounded apex, the small and sharp sutural spine, the probable presence of an apical portion of the elytral humeral spot, a slightly sinuate, transverse medial fascia with an extended and downward directed apical portion, and a slightly transverse basal portion of the apical spot. This is the first record of a tiger beetle in Rovno amber and only a fourth well-preserved Cicindelidae from fossil resins.

Investigating reverse butterfly fractures: An experimental approach and application of fractography

Butterfly fractures are expected to form with the transverse portion on the tension side and the wedge portion on the compression side of a bent bone, however wedges have also been observed in the reverse orientation and are reported to be frequent in concentrated 4-point bending. To investigate how these fractures form, concentrated 4-point bending experiments were performed on nine human femora and documented using high-speed video. Videos showed the wedge portion formed as fracture initiated in tension, branched obliquely, then curved to terminate on the tension face. The transverse portion formed as a crack traveled between the curved fracture branch and the compression face. Fractography was also applied to evaluate fracture surfaces. At least one fractography feature was present in all femora and 32/35 bone fragments examined. Fracture propagation sequences interpreted using fractography matched those observed on video, demonstrating the utility of this method for evaluating complex fracture patterns.

Effect of the addition of cactus (O. ficus-indica) to the lactating sows' diet on piglet development at lactation and post-weaning

Objective:The aim was to evaluate the effect of cactus (Opuntia ficus-indica) to the lactating sows’ diet on piglet development at lactation and post-weaning.Materials and Methods:Twenty-four litters of hybrids sows were evaluated in this study. The sows were divided into two groups: Control (CG), sows fed conventionally and experimental (EG), sows fed with commercial fed plus cactus. Post-weaning, the piglets of both groups were monitored up to the 20 kg liveweight (LW). It was evaluated, lactation (in sows): feed intake (FI), milk production (MP), and quality (MQ) and LW of the piglet. Post-weaning (in piglets): FI, LW, and length of intestinal villi (LIV) at 0, 24 h, and 42 days post-weaning.Results:FI sow-1 was higher in EG (p < 0.05). MP, MQ, and LW piglet-1 at weaning were equal (p > 0.05). FI piglet-1 in the sixth and eighth week of age was higher in EG (p < 0.05); at the end of weaning phase, EG presented higher LW (p < 0.05): 8.4% more. LIV of the jejunum were higher (p < 0.05) in EG at 48 h (28.8%) and 42 days post-weaning (29.9%). At day 0, post-weaning LIV of the descending portion was higher (p < 0.05) in CG (1,571.0 μm) versus EG (1,058.0 μm). At day 42, post-weaning LIV of the transverse portion was higher (p < 0.05) in EG: 23.7% higher.Conclusion:Cactus intake in lactating sows does not affect the piglet development. However, post-weaning piglets present higher LIV in jejunum and transverse portion, aspect that improves LW.

A Posterior Approach to Open Reduction and Internal Fixation of Displaced Posterior Cruciate Ligament Tibial Osseous Avulsions.

The true prevalence of displaced tibial-sided avulsion injuries of the posterior cruciate ligament (PCL; Video 1) is unknown, and the majority of data regarding management has been published in areas other than the Western world, such as China and India (perhaps due to the higher prevalence of two-wheeler motorcycle accidents in these areas). Despite the rarity of data, a better understanding of the approach, fixation techniques, and outcomes is necessary to provide quality patient care. These injuries generally require surgical intervention as nonoperative management leads to complications-specifically, knee arthrofibrosis1,2. There is no consensus regarding the optimal surgical approach for these injuries. A recent systematic review demonstrated that both open and arthroscopic surgical treatment provide satisfactory complication rates and outcomes in the majority of cases3. However, the arthroscopic approach can be performed by only a highly skilled arthroscopist; thus, in this article we focus on the open approach to reach a broader audience of capable surgeons. The principal steps for open reduction and internal fixation of the tibial avulsion fracture include the following:Place the patient in a prone position and utilize a curvilinear L-shaped incision with the longitudinal portion over the medial head of the gastrocnemius muscle and the transverse portion starting distal to the joint line and extending laterally past the midline.Develop the interval between the semimembranosus and medial gastrocnemius muscles, as originally described by Burks and Schaffer4. Lateral retraction of the gastrocnemius muscle exposes the posterior aspect of the capsule, allowing for a vertical capsular incision to adequately visualize the avulsed osseous fragment.Prepare the osseous bed and remove hematoma and/or debris.Reduce the avulsed fragment and obtain provisional fixation with Kirschner wires.Confirm reduction under fluoroscopy with emphasis on sagittal plane alignment.Obtain definitive fixation with the method dictated by the fracture orientation. Options include screw(s) with or without a washer, sutures, Kirschner wires, staples, and toothed plates2,5-7. An arthroscopic approach can be performed, with results that are similar to those of an open procedure, but considerable expertise is required to perform this procedure arthroscopically. Nonsurgical management is not recommended as it frequently leads to loss of knee motion. The exact operative indications for PCL injuries remain in question, but we believe that displaced tibial avulsion injuries at the PCL attachment always require operative treatment.

Modelling of pulse train generation for resonant laser wakefield acceleration using a delay mask

A new method for the generation of a train of pulses from a single high-energy, ultra short pulse is presented, suited for Resonant Multi-Pulse Ionization injection (Tomassini, 2017). The method is based on different transverse portion of the pulse being delayed by a “mask” sectioned in concentric zones with different thicknesses, in order to deliver multiple laser pulses. The mask is placed right before the last focusing parabola. A hole in the middle of the mask lets part of the original pulse to pass through to drive electron injection. In this paper a full numerical modelling of this scheme is presented. In particular we discuss the spatial and temporal profile of the pulses emerging from the mask and how they are related to the radius and thickness of each section.

Segmental branching pattern of the left portal vein: Anatomical characteristics and clinical implications

The existing knowledge on anatomy of segmental branches of left portal vein (LPV) is limited. This study aims to describe the surgical anatomy and variations of LPV and its segmental branching pattern. Forty fresh cadaveric liver dissections were performed. The dissection of LPV was carried out from its emergence at the level of the portal vein bifurcation to its segmental branches penetrating the left hemiliver. LPV characteristics, the number, and situation of its segmental branches were recorded. LPV comprises two portions: a 28 ± 6.7 mm-long transverse portion (TPLPV) and a 34.9 ± 4.4 mm-long umbilical portion (UPLPV). Mean number of LPV branches to segments I, II, III, and IV was 2 ± 1 (1-6), 2 ± 1 (1-4), 2 ± 1 (1-5), and 8 ± 2 (4-14), respectively. A single large vein supplied segment II in 90% of the cases. Segment III constantly had one vein arising from the left horn of UPLPV with mean diameter of 5.9 ± 1.6 mm. Most of the veins to segment IV took origin from the right horn of UPLPV with a mean number of 5 ± 2 (2-8). Segmental veins arising from UPLPV and TPLPV and supplying segment IV were present in 90 and 45% of the cases respectively. Segmental veins arising from LPV are often multiple and variable in position. Detailed knowledge of these veins is mandatory in order successfully perform anatomical liver resections or monosegment graft harvest for pediatric liver transplantation. Clin. Anat. 31: 1122-1128, 2017. © 2017 Wiley Periodicals, Inc.

Superior mesenteric artery syndrome

Superior mesenteric artery syndrome (SMAS) is a rare condition caused by compression of the transverse portion of the duodenum between the superior mesenteric artery (SMA) and the aorta, causing symptoms of duodenal outflow obstruction. We report a case of superior mesenteric artery syndrome in a 25-year-old female associated with rapid loss of weight and intermittent vomiting and resulting in severe duodenal compression that necessitated surgical treatment.

Delaminating infraspinatus tendon tears with differential retraction: imaging features and surgical relevance.

To describe infraspinatus tendon injuries with associated intramuscular edema in light of more recently elucidated anatomical knowledge. A retrospective review was performed to identify MRI cases with infraspinatus tendon injury accompanied by muscle edema. MR images were reviewed to evaluate the location of the injury, to assess the degree of tendon retraction, and to assess for muscular changes. Clinical and surgical data were reviewed when available. Twenty-three patients were identified (13 males, 10 females, mean age of 52years). MRI demonstrated infraspinatus muscle edema in all cases with variably retracted infraspinatus tendon fibers. Three patients (13%) presented acutely after traumatic falls, 11 patients (48%) presented after a minor trauma or recalled event, and 9 patients (39%) presented with more chronic symptoms. Of the nine patients who underwent arthroscopic surgery, six patients (67%) did not have an identifiable corresponding lesion, despite the findings described on the preoperative MRI. In these six cases, some superficial fibers of the transverse portion of the infraspinatus tendon remained intact on the MRI. Three patients (13%) had follow-up MRI examinations with one progressing to severe muscle atrophy, one without progression of existing muscle atrophy, and one with no atrophy on the initial or subsequent evaluation. Eighteen of 23 patients had concomitant partial-thickness or full-thickness tears of the adjacent supraspinatus tendon. Injuries of the infraspinatus tendon with resultant muscle edema and variable muscle atrophy may, in fact, represent delaminating type injuries with differential retraction of a layered tendon and may be missed on arthroscopy.

Wilkie's syndrome with duodenojejunal diverticulosis: A rare combination causing duodenal obstruction

Wilkie's 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 superior mesenteric artery (SMA). This results in chronic, intermittent, or acute complete or partial duodenal obstruction. We present the case of a 40-year-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 with SMA syndrome with duodenojejunal diverticulosis. She was taken for surgery due to chronic malnutrition that did not improve with conservative management. Duodenojejunostomy with transgastric feeding jejunostomy was done. To alleviate postoperative refractive gastroparesis, kinking, and angulation as is our previous few cases, transgastric feeding jejunostomy was done in contrast to modified Witzel's technique. The patient was free of symptoms and recurrence during follow-up. Wilkie's syndrome is an unusual cause of intestinal obstruction. Prompt diagnosis and appropriate surgical intervention are associated with good outcome.

Clinicopathological characteristics and surgical treatment of duodenal gastrointestinal stromal tumor

To investigate the clinicopathological characteristics and surgical treatment of duodenal gastrointestinal stromal tumor (GIST). Clinicopathological data of 25 cases with duodenal GIST from January 2007 to July 2011 in West China hospital were retrospectively analyzed. All the patients were identified by pathological examination without specific symptoms. Tumors were located in the bulb area in 2 cases, descending portion in 11 cases, transverse portion in 8 cases, and ascending portion in 4 cases. Two cases were at very low risk, 7 at low risk, 6 at intermediate risk, and 10 at high risk. All the patients received surgical resection, including 11 pancreaticoduodenectomies, 10 local tumor resections, 2 duodenal segmental resections, and 2 distal subtotal gastrectomies. Eighteen patients were followed up from 16 to 39 months and 3 patients recurred 18, 30, and 35 months after operation respectively. Duodenal GIST exhibits no distinct clinical characteristics. Complete removal of the tumor is the main choice of treatment.

Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices from Unconventional Systemic Veins in the Absence of Gastrorenal Shunts

Balloon-occluded retrograde transvenous obliteration of gastric varices in the absence of a gastrorenal shunts can still be performed through unconventional venous routes, such as the left inferior phrenic (ascending portion or transverse portion), pericardial, and azygous-hemiazygous veins. This requires detailed knowledge of venous anatomy, impeccable preprocedural imaging for planning, and high-skill set techniques with smaller balloon-occlusion catheters. The technical results appear to be high (67%-83% depending on the access venous system available), but are lower than conventional balloon-occluded retrograde transvenous obliteration via the gastrorenal shunt.

Right Hemihepatectomy in Presence of Congenital Absence of Portal Vein Bifurcation: A Challenging but Feasible Procedure

Preoperative radiologic findingsAs an example, we present a 3-phase liver CT scan with3-dimensional vascular reconstruction performed for vol-ume estimation in a patient who is a candidate to undergoRH for a single large liver metastasis from colorectal neo-plasm localized in the right liver and invading the righthepatic vein. The images demonstrate the congenital ab-sence of PV bifurcation at the hilum, with the main PVentering the liver like a right paramedian vein, then cross-ing the liver parenchyma of segment IVb transversally to-ward the left and reaching the umbilical fissure, where itturns down and, in the inferior surface of the liver, formsthe Rex’s recessus with its branches for segments II and III(Fig. 1). As reported previously, the intraparenchymalLBPVformsanarch,withanascendingportionrunningintherightparamediansectorreleasingbranchesforsegmentV and a transverse portion releasing branches for segmentVIII; the portal supplies for the right paramedian sectororiginatefromtheexternalanddorsalpartofthearch,andthe internal aspect embraces the origin of the median he-patic vein and release branches for segment IVb (Figs. 1A,1B). As shown in Figure 1C, a preoperative 3-dimensionalvascularandparenchymalreconstructionroutinelyusedinourcenterbeforeeverymajorliverresectionwashelpfultoplanthelineoftransectiontosparetheportalsupplyfortheremnant left liver.Surgical techniqueThe patient is placed in a supine position. A J-shaped in-cisionisusedtoentertheperitonealcavity.ThefirststepistodissectthemainPVatthehilumandplaceavessel-looparoundit.Theanatomyofthearterialandbiliarysystemisverified and is usually found to follow the normal branch-ing pattern, as demonstrated by Couinaud.

P-0132 Different Parts of Gastrointestinal Stromal Tumor: Clinical Features and Treatment

ABSTRACT Introduction To investigate and describe the clinical characteristics diagnosis, treatment and prognosis of different parts of gastrointestinal stromal tumor Methods Clinical data of 592 cases of gastrointestinal stromal tumor patients at our hospital between August 1999 and September 2011 were retrospectively analyzed. Results Tumors were located in the stomach in 405 patients (68.4%), the duodenum in 32 patients (5.4%), the small intestine in 99 patients (16.7%) and external gastrointestinal tract in 56 patients (9.5%). Different parts of GIST patient exhibits no distinct clinical characteristics. All patients accepted operation and were identified by methods of pathology and immunohistochemistry. 93.1%, 96.9%, 93.9%, 89.3% were positive for CD117 in stomach, duodenum, small intestine and external gastrointestinal tract, separately. Stomach: 35 cases (8.6), 160 cases (39.5%), 169 cases (41.8%), 41 cases (10.1%) were located in cardiac part, fundus of stomach, body of stomach, pyloric part, separately. The very low risk were 99 cases (24.4%), low risk were 117 cases (28.9%), intermediate risk were 68 cases (16.8%) and high risk cases were 121 cases (29.9%). With follow-up of 196 patients, 21 cases progressed. Duodenum: 6 cases (18.8%), 13 cases (40.6%), 6 cases (18.8%), 7 cases (21.8%) were located in the bulb area, descending portion, transverse portion and ascending portion separately. The very low risk were 2 cases (6.3%), low risk were 16 cases (50%), and high risk cases were 14 cases (43.7%). With follow-up of 20 patients, 5 progressed. Small intestine: 68 cases (68.7%), 31 cases (31.3%) were located in jejunum, ileum, separately. The very low risk were 2 cases (2%), low risk were 25 cases (25.3%) and high risk cases were 72 cases (72.7%). With follow-up of 60 patients,14 progressed. External gastrointestinal tract: 23 cases (41.1%), 18 cases (32.1%), 8 cases (14.3%), 7 cases (12.5%) were located in mesentery, omentum, omentum, retroperitoneal, pelvic, separately. The very low risk were 1 case (1.8%), low risk were 8 cases (14.3%), and high risk cases were 47 cases (83.9%). With follow-up of 28 patients, 14 progressed. Conclusion Different parts of GIST patient exhibits no distinct clinical characteristics. GIST located in small intestine and external gastrointestinal tract may have a higher risk and worse prognosis compared to GIST located in stomach. GIST claims our attention, because the incidence has increased on recent years.

Superior Mesenteric Artery Syndrome: A Rare Cause of Intestinal Obstruction. Diagnosis and Surgical Management

Superior mesenteric artery syndrome is a rare but well-known clinical entity characterized by compression of the third or transverse portion of the duodenum against the aorta by the superior mesenteric artery, resulting in chronic, intermittent, or acute, complete or partial, duodenal obstruction. The treatment for this arteriomesenteric compression includes conservative measures and surgical intervention. The aim of the study was to evaluate our surgical management and outcomes of the patients with superior mesenteric artery syndrome. The cases with superior mesenteric artery syndrome admitted between January 2000 and January 2010 were retrospectively investigated from the patients' records. All six patients had a history of chronic abdominal pain, nausea, postprandial early satiety, vomiting, and weight loss. Diagnostic methods included barium esophagogastroduodenography, upper gastrointestinal endoscopy, and computed tomography. Medical management was the first step of treatment in all cases before surgery. Of those, four underwent Roux-en-Y duodenojejunostomy and two underwent gastroenterostomy. Postoperative periods were uneventful and mean duration of hospitalization after the operations was 7days. Conservative initial treatment is usually followed by surgical intervention for the main problem that is the narrowing of the aortomesenteric angle in patients with superior mesenteric artery syndrome. This syndrome should be considered in the differential diagnosis in patients with chronic upper abdominal pain. Duodenojejunostomy is the most frequently used procedure with a high success rate.

Wilkie′s syndrome: A case report with review of literature

Wilkie's syndrome, well known as superior mesenteric artery syndrome, is a rare but well-recognized clinical entity causing upper abdominal symptoms. A 26-year-old woman presented with recurrent upper abdominal pain, vomiting, loss of weight, early satiety, and fullness of upper abdomen for 2 years. She was subjected to open appendicectomy and laparoscopic adhesionolysis within 20 months without relief. Clinical suspicion and thorough investigation revealed compression at transverse portion (third part) of duodenum. Though ideally a duodenojejunostomy is preferred, due to technical reasons an anterior gastrojejunostomy was performed, which resulted in relief of obstructive symptoms.