Superior Mesenteric Artery Syndrome: An Infrequent Complication of Scoliosis Surgery

Keskin, Metin; Akgül, Turgut; Bayraktar, Adem; Dikici, Fatih; Balık, Emre

doi:10.1155/2014/263431

Cited by 10 publications

(9 citation statements)

References 28 publications

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“…According to a metaanalysis of post-deformity correction SMA syndrome, 73.1% were treated conservatively 26.9% were managed operatively after the conservative treatment failed [ 44 ]. A variety of surgical options for failure of conservative management are now available- Duodenojejunostomy [ 28 , 29 ] being the most commonly done procedure, involves constructing an anastomosis to bypass the obstruction in the third part of the duodenum. However, the final decision of type of procedure is up to the surgeons discretion.…”

Section: Discussionmentioning

confidence: 99%

Delayed presentation of Wilkie’s syndrome after scoliotic curve correction surgery: a case report

Rathod,

Ved,

Jain

et al. 2024

BMC Musculoskelet Disord

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Background Superior mesenteric artery (SMA) syndrome, also known as Wilkie’s syndrome, is a rare but serious complication following scoliosis correction surgery. It occurs as a result of mechanical compression of third part of duodenum between the SMA and aorta. This condition occurs most commonly in significantly underweight patients with deformities, and usually during the first week following spinal deformity corrective surgeries. The angle between the abdominal aorta and the SMA gets reduced following spinal lengthening during deformity correction surgery causing compression of third part of duodenum resulting in development of SMA syndrome. Case presentation. We present a case of 17-year-old male with congenital scoliosis with a 70-degree scoliotic curve who underwent spinal deformity correction surgery with posterior instrumented fusion. Post-operative course was uneventful and the patient was discharged after suture removal on post-operative day 15. The patient presented after 21-days of symptom onset on post-operative-day 51, with a 3 week history of post-prandial vomiting, abdominal pain and distension which resulted in rapid weight loss of 11 kg. A CT-angiogram showed obstruction at third part of duodenum. After reviewing clinical and radiological profile of the patient, a diagnosis of SMA syndrome was made. Conservative management was tried, but due to rapid deterioration of patient condition and symptoms of complete intestinal obstruction, the patient was treated surgically by gastro-jejunostomy and side-to-side jejuno-jejunostomy, which improved his condition. Conclusion SMA syndrome can occur much later than previously reported cases and with potentially life-threatening symptoms following scoliosis correction. Having a high index of suspicion, early recognition of condition and institution of appropriate treatment are essential to prevent occurrence of severe complications including risk of intestinal perforation and mortality. This case highlights management of delayed onset of SMA syndrome, with presentation further delayed after symptom onset, as is common in developing parts of the world, due to limited availability and accessibility of resources, and low socio-economic status of large segments of the population.

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Section: Discussionmentioning

confidence: 99%

Delayed presentation of Wilkie’s syndrome after scoliotic curve correction surgery: a case report

Rathod,

Ved,

Jain

et al. 2024

BMC Musculoskelet Disord

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“…Failure of conservative treatment might result in life-threatening conditions such as metabolic alkalosis, electrolyte imbalance, and aspiration pneumonia. 20 Surgery such as gastrojejunostomy, 14 duodenojejunostomy, 21,22 Ladd procedure, 23 and total gastrectomy with esophagojejunal anastomosis 24 may be required. Our patients had responded well to conservative management and no additional surgeries were required.…”

Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery syndrome: A rare complication of scoliosis corrective surgery

Chung

Anuar

Lee

et al. 2020

J Orthop Surg (Hong Kong)

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Superior mesenteric artery (SMA) syndrome is a rare but serious complication following scoliosis surgery. Early diagnosis and management are key factors for successful conservative treatment to avoid the need for emergency laparotomies which causes higher morbidity or even mortality. We report two adolescent idiopathic scoliosis patients with Cobb angle of 49° and 132°, respectively, and low body mass index who presented with SMA syndrome following posterior spinal fusion from T2 to L3 and were treated successfully with conservative management. Abdominal radiographs showed distended gastric shadow. Computed tomography angiography of the abdomen showed decreased aortomesenteric angle and SMA-aorta distance. Both patients were treated successfully with conservative treatment which included three principles: gastric decompression with nasogastric tube, correction of electrolytes imbalance, and nutritional support with low volume, high calorie nutritional supplement. Both patients were started with small but frequent meals. Surgeries were not required in both cases. Early diagnosis and management are the key factors to successful treatment in SMA syndrome. Patients with SMA can be treated successfully with conservative treatment comprising of nasogastric decompression, electrolyte correction, and nutritional support with small but frequent meals.

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“…Other factors that may narrow the vascular angle and contribute to the development of SMAS include surgical treatment of scoliosis, high insertion of the duodenum/short ligament of Treitz, peritoneal adhesions, duodenal malrotation, and low origin of the superior mesenteric artery [1,2,16,[22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic options in superior mesenteric artery syndrome in children: systematic review

Costa

Saxena

2019

J Ped Endosc Surg

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Superior mesenteric artery syndrome (SMAS) refers to the compression of the third portion of the duodenum between the aorta and the superior mesenteric artery, and usually results from weight loss or alteration in spine anatomy. This study reviewed laparoscopic options regarding SMA S in children. Methods MEDLINE/PubMed was reviewed. Studies in patients under 16 years of age and published in English/Spanish were included, and selected by two independent reviewers. Data were collected for age, gender, weight/body mass index, comorbidities, symptoms, surgical technique, complications, conversions, recurrence and mortality. Descriptive statistics were used to analyze the quantitative portion of the study, with results presented as percentages, means and medians. Results Twelve papers with n = 16 patients were included. Mean/median age were 10.7 and 13 years, respectively, with female predominance (n = 11, 68.75%). Emesis (n = 15, 93.75%) and abdominal pain (n = 11, 68.75%) were the most common symptoms. Anorexia nervosa was present in n = 1, and n = 1 patient had recent history of spinal fusion for idiopathic scoliosis. Regarding surgical technique, eleven cases consisted of duodenojejunostomy with side-to-side anastomosis (one associated with feeding jejunostomy); two Strong's procedures; and three Ladd's procedures. There were no conversions, and n = 2 (12.5%) minor complications (self-limited upper gastrointestinal bleed and persistence of vomiting for 48 h postoperatory). There was no mortality. Mean and median follow-up were 44.5 and 48 weeks, respectively, with no recurrences. Conclusions SMAS is uncommon in children. The preferred laparoscopic approach is duodenojejunostomy, which can provide definitive relief of the obstruction with minor complications and low recurrence.

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Superior Mesenteric Artery Syndrome: An Infrequent Complication of Scoliosis Surgery

Cited by 10 publications

References 28 publications

Delayed presentation of Wilkie’s syndrome after scoliotic curve correction surgery: a case report

Delayed presentation of Wilkie’s syndrome after scoliotic curve correction surgery: a case report

Superior mesenteric artery syndrome: A rare complication of scoliosis corrective surgery

Laparoscopic options in superior mesenteric artery syndrome in children: systematic review

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