Superior mesenteric artery syndrome caused by weight loss in a malnourished Syrian man

Superior mesenteric artery syndrome is a rare cause of upper gastrointestinal obstruction in which the third part of the duodenum is compressed between the superior mesenteric artery and the abdominal aorta,and the compression of the duodenum is caused by a narrowed aortomesenteric angle.We report in this case a 35-year-old patient who came with features of small bowel obstruction,weight loss and had a history of malnutrition because of war.Multi-slice computerized tomography showed a narrowed aortomesenteric angle and distance.Conservative treatment was presented and,after 3 months of observation,the patient gained weight.

Using the stent-in-stent technique to drain the right hepatic duct,passing across a 7-year-old obstructed spiral self-expandable metal stent of the left hepatic duct

Introduction Endoscopic stent implantation is a widely used and accepted palliative procedure for non-operated malignant hilar biliary obstruction[1].Several studies have demonstrated that selfexpandable metal stents(SEMS)are superior to plastic stents(PS)[2,3].However,it is still debated whether bilateral stenting is better than unilateral stenting[2,3].Park et al.reviewed the literature and clarified that bilateral stenting is favored,due to better clinical outcomes and fewer late complications[2].It is technically challenging to place two SEMS beside each other in order to do bilateral stenting[1,2].For the above considerations,a new technique called‘stent-in-stent’(SIS)has been developed[1].In this method,a Y-stent with a central open mesh allows a second stent to be introduced into the contralateral bile duct[1],resulting in a technical success ranging from 80%to 100%[2].