Abstract
IntroductionObstruction of the third part of the duodenum by the superior mesenteric artery (SMA) can occur following surgical correction of scoliosis. The condition most commonly occurs in significantly underweight patients with severe deformities during the first few days to a week following spinal surgery.Case presentationWe present the atypical case of a patient with normal body habitus and a 50° adolescent idiopathic thoracolumbar scoliosis who underwent anterior spinal arthrodesis with instrumentation and developed SMA syndrome due to progressive weight loss several weeks postoperatively. The condition manifested with recurrent vomiting, abdominal distension, marked dehydration, and severe electrolyte disorder. Prolonged nasogastric decompression and nasojejunal feeding resulted in resolution of the symptoms with no recurrence at follow-up. The spinal instrumentation was retained and a solid spinal fusion was achieved with good spinal balance in both the coronal and sagittal planes.ConclusionSMA syndrome can occur much later than previously reported and with potentially life-threatening symptoms following scoliosis correction. Early recognition of the condition and institution of appropriate conservative measures is critical to prevent the development of severe complications including the risk of death.
Highlights
Obstruction of the third part of the duodenum by the superior mesenteric artery (SMA) can occur following surgical correction of scoliosis
White blood cell, and lymphocyte counts were all within normal limits. She underwent an anterior spinal arthrodesis extending from T10 to L2 with the use of third generation instrumentation [AO-Universal Spine System (USS) II, Stratec Medical, Oberdorf] applying a spinal derotational effect and autologous rib bone graft performed through a left thoracoabdominal retroperitoneal approach to the spine
We present a patient with an adolescent idiopathic scoliosis who underwent anterior spinal arthrodesis and developed severe SMA syndrome 6.5 weeks following surgery
Summary
We believe that it is essential to identify those patients who are at greater risk of developing duodenal obstruction and initiate intensive preoperative dietary supplementation in undernourished patients scheduled to http://www.jmedicalcasereports.com/content/2/1/9 undergo complex spine deformity surgery as a preventative measure. We have described a patient who demonstrates that SMA syndrome can develop late following scoliosis surgery, a finding that is consistent with etiology of gradual onset. A high index of suspicion will lead to an early diagnosis of the condition at a stage when conservative measures are more likely to produce a good outcome. 7. Hutchinson DT, Bassett GS: Superior mesenteric artery syndrome in pediatric orthopedic patients. 8. Munns SW, Morrissy RT, Golladay ES, McKenzie CN: Hyperalimentation for superior mesenteric-artery (cast) syndrome following correction of spinal deformity. 9. Braun SV, Hedden DM, Howard AW: Superior mesenteric artery syndrome following spinal deformity correction.
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