Feasibility and Surgical Outcomes of Simultaneous Laparoscopic Management of Superior Mesenteric Artery Syndrome and Hiatus Hernia

Abstract Background Superior mesenteric artery (SMA) syndrome, or Wilkie’s syndrome, is a rare cause of proximal intestinal obstruction resulting from compression of the third part of the duodenum between the SMA and the abdominal aorta. Its coexistence with hiatus hernia is extremely uncommon, complicating both diagnosis and management. Case Presentation: We report a 20-year-old female presenting with persistent vomiting, continuous regurgitation, chest discomfort, and significant weight loss. Her medical history included Helicobacter pylori infection, chronic gastritis, and gastroesophageal reflux disease, which were managed medically without long-term relief. Upper gastrointestinal endoscopy revealed diffuse gastritis and a Hill’s class II hiatus hernia, while contrast-enhanced CT scan demonstrated a reduced aortomesenteric angle (18°) and distance (6 mm) consistent with SMA syndrome. Management and Outcome: The patient underwent simultaneous laparoscopic duodenojejunostomy and Nissen fundoplication. Postoperatively, she tolerated oral intake, experienced resolution of vomiting and reflux, and had an uneventful recovery. Follow-up confirmed sustained symptomatic relief and improved quality of life. Conclusion This case highlights the importance of considering SMA syndrome in patients with persistent vomiting and weight loss, and demonstrates the feasibility and efficacy of combined laparoscopic management for coexisting SMA syndrome and hiatus hernia.