Superior mesenteric artery syndrome in a young girl following spinal surgery for scoliosis

Abstract

A 15-year-old girl was admitted with nausea, severe bilious vomiting, loss of appetite and loss of weight of 2 weeks' duration. She underwent spinal surgery for thoracic scoliosis with multiple congenital abnormalities of the spine 3 weeks before admission. Examination revealed a thin, dehydrated patient with distended upper abdomen, positive succussion splash and normal bowel sounds. Blood investigations including urea and electrolytes were normal except for mild leucocytosis. Abdominal X-ray was unremarkable. A nasogastric tube was inserted which drained 2–3 litres of bilious fluid each day. She was treated conservatively with intravenous fluids and anti-emetics. The history of spinal surgery and copious amount of bilious nasogastric aspirate suggested upper gastrointestinal obstruction for which a barium meal with follow through was done on day 3 (Figures 1 and 2). It revealed a distended stomach and dilatation of the first and second parts of the duodenum with an abrupt linear cut-off at the third part, suggesting extrinsic compression. On the basis of her history and radiological findings, the diagnosis of superior mesenteric artery syndrome was made. Conservative treatment was continued with total parenteral nutrition for about 3 weeks, by which time the nasogastric output gradually reduced to less than 100 ml and the patient was tolerating oral fluids The patient was discharged after 4 weeks on soft diet. She was reviewed in clinic after a month and was found to be completely asymptomatic and comfortable.