Robotic management of superior mesenteric artery syndrome after weight loss: a case report

Superior mesenteric artery (SMA) syndrome is a rare cause of proximal intestinal obstruction resulting from compression of the third portion of the duodenum between the aorta and the SMA. It most commonly occurs in slender individuals or those experiencing rapid weight loss, but presentations can be atypical and diagnostically challenging. We report the case of a 28-year-old female with history of postural orthostatic tachycardia syndrome and gastroparesis who presented with recurrent nausea and intractable vomiting following a 110-lb weight loss after prior obesity. Upper gastrointestinal endoscopy and gallbladder ultrasonography were unremarkable. Computed tomography of the abdomen demonstrated findings consistent with SMA syndrome, including severe narrowing of the aortomesenteric angle and reduced aortomesenteric distance. The patient subsequently underwent robotic-assisted duodenojejunostomy with resolution of symptoms. This case highlights an atypical presentation of SMA syndrome following massive weight loss and demonstrates the feasibility of robotic duodenojejunostomy as an effective treatment option.