Baraa K. Alnabulsi
King Fahad General Hospital, Kingdom of Saudi Arabia
Dr. Alnabulsi has completed his MD degree from King Abdulaziz University, Jeddah, Saudi Arabia. He has been active in the field of research and publication since his forth year of medical school. He has presented in several reputable conferences. He also reviewed papers in journals. He invented a device that improves the dibasic foot circulation. He was recognized by “Marquis Who's who in the world” for year 2013, for his academic and athletic achievements.
Introduction: Superior Mesenteric Artery (SMA) syndrome is a rare condition in which the SMA compresses the third portion of the duodenum. The following are the first two SMA syndrome cases to be reported in Saudi Arabia. Roux En Y anastomosis or Lateral Doudenojejunostomy is used to treat this syndrome surgically. Yet, this is the first time to use laparoscopic Omega Loop (Lateral Doudenojejunostomy) with Braun anastomosis (Jejunojejunostomy) for treating this syndrome. Case 1: A 24-year-old woman was presented with 4 years history of vague abdominal pain mainly at the epigastric region, associated with repeated vomiting. The patient had also lost significant weight during the last six months. SMA syndrome was confirmed using CT scan and fluoroscopy. The patient was planned for laparoscopic Omega loop with Braun anastomosis as treatment. Case 2: A 19-year-old woman was presented with 2 days history of sever recurrent emesis and vague abdominal pain. Six weeks prior to her presentation, she had been diagnosed with SMA syndrome using CT and fluoroscopy in another hospital, where Laparoscopic Lateral Doudenojejunostomy was preformed. We performed Braun anastomosis later on in order to connect the two limbs of the Omega loop that had been created by the previous team. Outcome: Both patients were followed up for six months. They gained weight and were doing well. Conclusion: To our knowledge laparoscopic Omega Loop with Braun anastomosis (double drainage) is the most appropriate surgical management of SMA syndrome in comparison to Roux En Y anastomosis or Lateral Doudenojejunostomy as our experience showed successful outcome.