Duodenojejunal Diamond-Shaped Anastomosis in Addition to Strong’s Procedure for Superior Mesenteric Artery Syndrome in a Child With Myotonic Dystrophy

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  • Yokoi Akiko
    Department of Pediatric Surgery, Kobe Children’s Hospital
  • Takeuchi Yuki
    Department of Pediatric Surgery, Kobe Children’s Hospital

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Other Title
  • 上腸間膜動脈症候群に対してStrong手術に十二指腸空腸ダイアモンド吻合を付加した手術が有効であった筋強直性ジストロフィーの1例
  • ジョウチョウカンマク ドウミャク ショウコウグン ニ タイシテ Strong シュジュツ ニ ジュウニシチョウ クウチョウ ダイアモンド フンゴウ オ フカ シタ シュジュツ ガ ユウコウ デ アッタ キン ゴウチョクセイ ジストロフィー ノ 1レイ

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Abstract

<p>We report the case of a girl with myotonic muscular dystrophy who developed superior mesenteric artery (SMA) syndrome and underwent duodenojejunal diamond-shaped anastomosis in addition to Strong’s procedure (hereafter, this method). Gastric nutrition became possible after this method. Her clinical course was as follows. Fundoplication and gastrostomy were performed at three years and one month of age. She developed SMA syndrome, and a gastrojejunal (GJ) tube was placed at the age of 6 years and 11 months. Although gastric nutrition became possible with a button-type gastrostomy catheter at the age of 7 years and 3 months, SMA syndrome recurred six months later, and the GJ tube was replaced. Retrograde intussusception had occurred around the tube since the age of 7 years and 11 months. However, given the risks of surgical intervention for muscular dystrophy, close observation was performed until it became difficult to replace the GJ tube at the age of 8 years and 3 months. Thus, Strong’s procedure was performed. Since flexion remained with maximum mobilization of the duodenum, we additionally performed duodenojejunal diamond-shaped anastomosis adopting physiological peristalsis. This method was deemed effective in muscular dystrophy children with significantly impaired gastrointestinal peristalsis.</p>

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