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Updated: Jul 1, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Superior Mesenteric Artery Syndrome After Previous Nuss Procedure: A Case Report of Anatomical Realignment With
Pin Wen Wang1, Chun-Hsiang Wang2, Hui-Ting Hsu3
1School of Medicine, China Medical University, Taichung, Taiwan, cmu.edu.cn.
Background:
Superior mesenteric artery (SMA) syndrome is a rare condition resulting from compression of the third segment of the duodenum. The condition is associated with a reduction of the aortomesenteric angle and distance between the SMA and the abdominal aorta, often due to weight loss or anatomical changes. The Nuss procedure, a minimally invasive corrective procedure for pectus excavatum, may inadvertently alter this anatomy.
Case Presentation:
We report a case of a 22-year-old male with a history of pectus excavatum who presented with two weeks of abdominal pain and vomiting. Abdominal A CT scan and esophagogastroduodenoscopy examinations were performed, revealing duodenal compression with a narrowed aortomesenteric distance of 6 mm, which is consistent with SMA syndrome. The patient then underwent laparoscopic duodenojejunostomy anastomosis bypass after failed conservative management with complete symptom resolution.
Conclusion:
Clinicians should be aware of the potential development of SMA syndrome in patients following the Nuss procedure. Monitoring nutritional status and prompt evaluation of gastrointestinal symptoms are essential to early diagnosis and intervention.