ハンドアシストによる腹腔鏡下根治的左腎摘除術施行後に上腸間膜動脈症候群を発症した1例

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A 65-year-old man with left renal cell carcinoma RCC underwent hand-assisted laparoscopic nephrectomy. He was discharged on the 8th hospital day, but 2 days later he was admitted to the hospital again because of vomiting and abdominal pain. Abdominal computed tomography (CT) showed a narrow space between the superior mesenteric artery (SMA) and aorta as well as distension of the proximal duodenum. Upper gastrointestinal radiographic studies with gastrografin showed abrupt vertical cut-off sign of the third part of the duodenum. Therefore, we diagnosed SMA syndrome. We started conservative management by nasogastric tube and total parenteral nutrition through a central venous line. The patient was able to eat on day 24 and was discharged on day 34 after the treatment. SMA syndrome is considered as a postoperative complication after abdominal surgery, but it is extremely rare. To our knowledge, only 4 cases of SMA syndrome following nephrectomy have been reported and this is the first case of SMA syndrome following laparoscopic nephrectomy.