Superior Mesenteric Artery Syndrome Associated with Total Situs Inversus

A 58-year-old man was admitted to Kagoshima University Hospital after developing acute-onset abdominal distension. He had experienced anorexia and had lost 2 kg over the previous 3 months. An upper GI series and abdominal CT suggested duodenal obstruction with superior mesenteric artery syndrome (SMAS) and total situs inversus (TSI). As obstructive symptoms were refractory to conservative treatment with naso-gastric decompression and positional change, surgical treatment was performed 14 days after his admission. At laparotomy, complete transposition of the abdominal organs was observed. Although malrotation of the jejunum was not identified, a fibrotic stricture of the Treitz ligament was found. The duodenum and jejunum were reconstructed with duodeno-jejunostomy and jejuno-jejunostomy. Symptoms improved after surgery and the patient was discharged after 30 days, with no postoperative complications. SMA syndrome is very rarely associated with TSI, and to our knowledge, this is the first report in the literature written by English