Superior mesenteric artery syndrome after laparoscopic sleeve gastrectomy.

Superior mesenteric artery syndrome is a duodenal obstructive complication, which has been reported after Roux-en-Y gastric bypass. We report a patient who presented a fistula at the angle of His after a laparoscopic sleeve gastrectomy, which was treated with endoscopic procedures and laparoscopic drainage. During this period, there was excessive, rapid weight loss to BMI 22 kg/m2. At 3 months after the fistula had closed, metrorrhagia was treated by blood transfusion and urgent hysterectomy. Following this, diarrhea occurred and worsened the malnutrition, and the BMI was 18. Duodenal obstruction occurred, confirmed by radiological studies and endoscopy. Duodenojejunostomy and choleystectomy were done, and there has been no recurrence of duodenal obstruction in the 14 follow-up months.