Superior mesenteric vein syndrome. A duodenal stenosis caused by atypical malpositioning of the superior mesenteric vein

Cases in which mesenteric vessels lead to stenosis of the duodenum are very rare. Several cases have been reported of patients suffering from stenosis of the last third of the duodenum due to a malpositioning of the superior mesenteric artery or the left renal vein. We report a 78-year-old patient w ho was suffering from dyspepsia, pain in the upper abdominal region, nausea , and vomiting. The medical history revealed that the patient had undergone a subtotal gastrectomy according to Billroth II at the age of 19 because o f similar complaints. In the last 20 years the patient had to be laparotomi zed several times for ileus of the small intestine. Now the patient present ed abdominal complaints with nausea and pressure in the upper abdominal reg ion. Assuming an efferent-loop syndrome and adhesions, the patient was lapa rotomized. We discovered malpositioning of the superior mesenteric vein, le ading to stenosis of the superior part of the duodenum. In fact, 60 years a go surgeons performed a duodenojejunostomy, circumvening the stenosis of th e duodenum. With a "delay of 60 years", we then performed a subtotal gastre ctomy according to Billroth II. The postoperative course was uneventful; th e patient had no complaints and increased in body weight. To our knowledge, this is the first time that a stenosis of the duodenum due to malpositioni ng of the superior mesenteric vein has been observed.