Late presentation of superior mesenteric artery syndrome following scoliosis surgery: a case report

Abstract

Introduction: Obstruction 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.

A comprehensive review of superior mesenteric artery syndrome

“…a) Severe debilitating illnesses or chronic wasting diseases: causing prolonged best rest and asthenic built like malignancy, cerebral palsy, paraplegia, juvenile rheumatoid arthritis [1], drug abuse [6], secondary to cardiac cachexia [14], AIDS [15,16]; b) Trauma: polytrauma patients in ICU [5,10,12], extensive burn injury [1,10,12], brain and spinal cord injury [12,13,17]; c) Dietary disorders: causing severe weight loss; malabsorption syndrome [12], anorexia nervosa (psychiatric disorder) [13]; d) Postoperative states: bariatric surgery [1,7,18], esophagectomy [7], aortic aneurysm repair, and traumatic mesenteric arteriovenous fistula following abdominal aortic aneurysm repair [4,12], spinal instrumentation, scoliosis with sagittal kyphosis causing severe trunk collapse, in vertebral fractures or external compression by a body cast (hence the name 'Cast Syndrome') [7], proctocolectomy, and ileoanal pouch anastomosis [4,19], Nissen fundoplication [20]; e) Local pathology: neoplastic growth in mesenteric root, dissecting aortic aneurysm [4], traumatic aneurysm of the SMA after a stab wound [12], a flaccid abdominal wall with visceroptosis [8,12], associated with peptic ulcer disease [12], in connective tissue disorders [21], unfrequently associated with coeliac axis compression syndrome [22], compression by a huge mycotic abdominal aortic aneurysm [23]; f ) Other conditions: increased lumbar lordosis as in pregnancy [2], in hyperthyroidism [4], weight loss due to ch...…”

“…Anatomical variants: A short mesenteric root [2], duodenal malrotation [12], a short or a high insertion of the ligament of Treitz at the duodenojejunal flexure can lead to an elevation of the duodenum to a more cranial position into the vascular angle [4,6,10,12], a congenitally low origin of the SMA, peritoneal adhesions and compressions by Ladd's bands [3,13].…”

“…3) [1,7]. Wilkie's syndrome was found to be highly associated with patients having a very low body mass index, usually below the 3rd percentile [10]. The etiology of the syndrome can be divided into two broad categories: A) congenital and B) acquired causes [11].…”

Radiographic Classification of Complications of Instrumentation in Adolescent Idiopathic Scoliosis

“…Previous studies have been comprehensive surgeon-reported complication rates [1]; descriptions of particular complications, such as infections [11], superior mesenteric artery syndrome [4,13], etc; complications related to a certain technique, such as thoracoscopic treatment [8,10]; or complications compared between different techniques, such as hooks versus screws [5,6,12]. Our aim was to define a radiographic system of * P values were calculated using an overall chi square test for all treatment groups for existence of a serious radiographic adverse event (p = 0.427) or a radiographic adverse event (p = 0.88); no significant difference was found between the different surgical treatments; OASF = open anterior instrumented spinal fusion; TASF = thoracoscopic anterior instrumented spinal fusion; PSFH = posterior instrumented spinal fusion with an anchor system that utilized hooks or hooks, wires, and screws (hybrid systems); PSFS = posterior instrumented spinal fusion with an anchor system that utilized a majority of pedicle screws.…”

Low Body Mass Index in Adolescent Idiopathic Scoliosis

“…Four patients experienced a major perioperative complication, namely pneumothorax requiring chest drain insertion (n = 2), SMA syndrome (n = 1), and type 1 respiratory failure (n = 1); the median hospital duration for this patient group was 22 days (interquartile range, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Fifty-seven patients experienced at least one minor complication (74%) ( Table 3).…”