Sacasa F, Ploneda C, Cervantes M, Betancourt B, Casal J, Bedoya J, Valladares W. Superior mesenteric artery syndrome and right paraduodenal hernia causing intestinal obstruction during pregnancy: A case report. World J Gastrointest Surg 2026; 18(5): 117565 [DOI: 10.4240/wjgs.v18.i5.117565]
Corresponding Author of This Article
Federico Sacasa, MD, Faculty of Medical Sciences, Universidad Nacional Autónoma de Nicaragua, 2nd North Street, Leon 21000, Nicaragua. federicosacasanic@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
case-report
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Sacasa F, Ploneda C, Cervantes M, Betancourt B, Casal J, Bedoya J, Valladares W. Superior mesenteric artery syndrome and right paraduodenal hernia causing intestinal obstruction during pregnancy: A case report. World J Gastrointest Surg 2026; 18(5): 117565 [DOI: 10.4240/wjgs.v18.i5.117565]
Federico Sacasa, Faculty of Medical Sciences, Universidad Nacional Autónoma de Nicaragua, Leon 21000, Nicaragua
César Ploneda, Misael Cervantes, Brenda Betancourt, Wiron Valladares, Cirugía Endoscópica y de Mínima Invasión Jalisco (CEMIJAL), Hospital Ángeles Andares, Zapopan 45116, Jalisco, Mexico
Jorge Casal, Department of Endoscopy, Hospital Ángeles Andares, Zapopan 45116, Jalisco, Mexico
Jair Bedoya, Department of Radiology, Hospital Real San José Valle Real, Zapopan 45136, Jalisco, Mexico
Author contributions: Sacasa F contributed to study conception, literature review, and manuscript drafting; Ploneda C, Cervantes M, Betancourt B, and Casal J contributed to clinical data collection, case documentation, and manuscript revision; Bedoya J contributed to radiologic interpretation and preparation of imaging figures; Valladares W contributed to project supervision, critical revision for important intellectual content, and overall guidance of the manuscript. All authors have read and approved the final manuscript.
AI contribution statement: The manuscript was written by the authors based on their direct clinical experience and interpretation of the case. ChatGPT was used for limited grammar and phrasing refinement. It did not contribute to the scientific content or data analysis. This is a case report based on direct clinical observation and management by the authors. All images are original clinical, radiological, or intraoperative images.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Federico Sacasa, MD, Faculty of Medical Sciences, Universidad Nacional Autónoma de Nicaragua, 2nd North Street, Leon 21000, Nicaragua. federicosacasanic@gmail.com
Received: December 11, 2025 Revised: January 31, 2026 Accepted: February 24, 2026 Published online: May 27, 2026 Processing time: 168 Days and 9.6 Hours
Abstract
BACKGROUND
Superior mesenteric artery (SMA) syndrome is exceptionally rare in pregnancy and may be misattributed to common gestational complaints. Coexistence with a right paraduodenal hernia further complicates presentation and increases the risk of obstruction. This report highlights diagnostic challenges in pregnancy-adapted imaging, where non-contrast computed tomography identified the hernia and raised suspicion for aortomesenteric compression, and illustrates operative decision-making in a scenario where definitive diagnosis was established intraoperatively.
CASE SUMMARY
An 18-week primigravida presented with a month of postprandial pain, emesis, and significant weight loss consistent with severe malnutrition. Pregnancy-adapted non-contrast computed tomography identified a right paraduodenal hernia with a whirlpool sign and suggested aortomesenteric duodenal compression, though the latter remained non-diagnostic owing to lack of contrast. Conservative management failed. Laparoscopy revealed proximal duodenal obstruction from SMA compression (Wilkie’s syndrome) and a paraduodenal hernia containing transverse colon, with evolving mesenteric torsion prompting conversion to supraumbilical laparotomy. The hernia was reduced and repaired transomentally. A wide, tension-free side-to-side duodeno-duodenostomy restored duodenal continuity while preserving physiological pyloroduodenal transit. Postoperative gastroparesis resolved after endoscopic confirmation of anastomotic patency, and maternal-fetal outcomes were favorable.
CONCLUSION
Timely operative intervention permitted duodeno-duodenostomy to preserve physiological pyloroduodenal transit in pregnancy-associated SMA obstruction with paraduodenal hernia.
Core Tip: Superior mesenteric artery syndrome is exceptionally rare, and its coexistence with a right paraduodenal hernia during pregnancy adds diagnostic and operative complexity. In this patient, pregnancy-adapted non-contrast computed tomography identified a right paraduodenal hernia and suggested aortomesenteric duodenal compression, with definitive superior mesenteric artery obstruction established intraoperatively. After internal hernia reduction, operative anatomy permitted a wide, tension-free side-to-side duodeno-duodenostomy - an uncommon but physiologically favorable alternative to duodeno-jejunostomy in this isolated setting. This case underscores the importance of early surgical decision-making, physiology-preserving reconstruction, and selective postoperative endoscopic assessment to safely enable early enteral nutrition in high-risk pregnant patients.
