Superior mesenteric artery (SMA) syndrome is a rare disorder caused by extrinsic compression of the third portion of the duodenum by the SMA. The operative treatment of choice is bypassing the obstructed duodenal segment by duodenojejunostomy. We report one case of SMA syndrome treated by laparoscopic duodenojejunostomy and followed up by 3D-reconstructive CT scan. A fifteen-year-old boy with intermittent vomiting and weight loss was admitted. Ultrasonography showed narrowing of the distance between the SMA and aorta. Hypotonic duodenography showed dilatation of duodenal third portion and barium stasis. On 3D-reconstructive CT scan, the angle between SMA and aorta was 37 °. The postoperative course was uneventful. Three months later, he had gained 3 kg of weight and the angle between SMA and aorta increased to 38-39 ° on 3D reconstructive CT scan. Laparoscopic duodenojejunostomy for bypassing the obstructive duodenum in SMA syndrome is a feasible and safe method.

Esophageal atresia without tracheoesophageal fistula accounts for 7-11% of all types of esophageal atresia and is very difficult to treat. In our hospital from 1990 to 2005, we operated upon 40 patients with esophageal atresia, and 6 had pure atresia. The preoperative characteristics, operative findings and post operative course of the six patients with pure atresia were analysed. Immediate gastrostomy was performed in all 6 patients. One patient had simultaneous cervical esophagostomy. Esophageal reconstruction procedures were transhiatal gastric pull up in 3 patients, esophagocologastrostomy utilizing left colon in 1, and transthoracic esophagoseophagostomy with esophageal bougination in 2. Postoperative complications were pneumonia, anastomosis leakage, and gastroesophageal reflux symptom. Conservative management was effective in all patients. A larger series of cases would be required to demonstrate the most effective treatment for this particular anomalous condition.