Superior Mesenteric Artery Syndrome Following Spinal Deformity Correction

Braun, Stuart V.

doi:10.2106/jbjs.e.00348

Cited by 30 publications

(35 citation statements)

References 18 publications

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“…3,7,8 This compression of the duodenum causes an extrinsic partial or complete obstruction of the duodenum (D3), resulting in chronic food intolerance, bloating, nausea, eructation, abdominal discomfort, and voluminous bilious vomiting along with secondary features like AD and generalized spasms, as observed in our group of patients. 9 However, confusion about the diagnosis develops, because many patients will continue to have good lower intestinal motility with bowel sounds and even bowel movements. 10 A further challenge in diagnosing this condition in patients with SCI arises because they may have neurogenic bowel dysfunction resulting in similar symptoms.…”

Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery syndrome – A rare presentation and challenge in spinal cord injury rehabilitation: A case report and literature review

Desai

Gall

Khoo

2014

The Journal of Spinal Cord Medicine

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Background: Obstruction of the third part of the duodenum (D3) is a very rare cause of gastric outflow obstruction. Rapid weight loss is the biggest risk factor. Patients seen in acute rehabilitation settings, not uncommonly, have a period of rapid weight loss. We report two cases of superior mesenteric artery (SMA) syndrome and review the literature. Clinical details: The patients presented differently, one with repeated, refractory autonomic dysreflexia and severe spasticity and one with nausea, abdominal discomfort, and vomiting. CT abdomen with contrast identified dynamic duodenal (D3) obstruction against the posterior structures by narrow angled SMA, gastric distension and, in one case, dilation of the left renal vein. Both patients responded well to optimizing nutrition in different ways. Surgery was successfully avoided. Discussion: SMA syndrome is an atypical cause of high intestinal obstruction, frequently occurring in patients who have had rapid weight loss during spinal cord injury (SCI) rehabilitation. It may co-exist with left renal vein dilation "nutcracker phenomena". The associated neurogenic bowel dysfunction due to the nature of SCI could possibly contribute to delay in diagnosis. Conclusion: Clinicians should consider the risk of SMA syndrome in patients with SCI with rapid weight loss. Early diagnosis is possible by doing a CT abdomen with contrast and angiography if there is a high index of suspicion. SMA syndrome can be successfully treated by aggressive nutritional management. This may include total parenteral nutrition or feeding by a nasojejunal tube. Duodenojejunostomy could be required in refractory cases.

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Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery syndrome – A rare presentation and challenge in spinal cord injury rehabilitation: A case report and literature review

Desai

Gall

Khoo

2014

The Journal of Spinal Cord Medicine

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“…However, superior mesenteric artery syndrome can have a similar presentation following scoliosis surgery and a high index of suspicion should be maintained as early diagnosis and surgical intervention can be lifesaving. [16]…”

Section: Discussionmentioning

confidence: 99%

Perioperative concerns in pediatric patients undergoing different types of scoliosis correction surgery: A retrospective observational study

Chhabra

Arora

Baidya

et al. 2013

J Anaesthesiol Clin Pharmacol

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Background:Advances in scoliosis surgery have now made it possible for younger patients to be taken up for scoliosis correction.Objectives:To ascertain the patient profile, perioperative complications and need for intensive care management in children undergoing posterior fusion and instrumentation (PF), anterior release (AR), and growth rod (GR) insertion surgery.Patients and Methods:After taking parental consent, data were collected retrospectively for 33 patients who underwent 37 procedures (four patients had both anterior and posterior procedures) on 2 days of the week mainly from August 2008 to February 2010 at a tertiary care institution.Results:Children undergoing GR surgery were younger (8.1 ± 2.1 years) than patients undergoing AR (12.9 ± 1.7 years) or posterior fusion (14.2 ± 2.2 years). AR children had a significantly higher Cobb's angle and more rigid curves. (P = 0.057) Associated congenital abnormalities especially neurological were commoner in the GR children. Surgical duration and blood loss was significantly more for PF (2207.5 ± 1224.13 ml) than GR (456 ± 337.5 ml), or AR (642.85 ± 304.72 ml), (P = 0.0002). PF patients needed Intensive care unit (ICU) care mainly due to the blood loss and prolonged surgery (35%). AR performed via thoracotomy was associated with the need for mechanical ventilation in 28.6%. The GR patients had major intraoperative hemodynamic events and 20% needed ICU care.Conclusions:Post-operative ventilation may be required in 20-35% patients undergoing procedures for scoliosis correction. Despite GR insertion involving lesser blood loss; younger age, congenital abnormalities, positioning, and surgical manipulation resulted in life threatening events in these patients.

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“…Adequate nutrition storage ensures sufficient energy supply and is crucial for orthopedics management in children with cerebral palsy (CCP) (Jevsevar and Karlin 1993;Lipton et al 1999;Braun et al 2006). An undernutrition stage in CCP undeniably associates with an increasing risk of postoperative complications (Jevsevar and Karlin 1993;Smith et al 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, alteration in nutritional status required some time before actual changes in physical parameters could be recognized (Soylu et al 2008). Biochemical markers, including serum albumin and total lymphocyte count, have also been recommended (Jevsevar and Karlin 1993;Braun et al 2006;Johnston 2010). However, studies have confirmed that these parameters might not be at times an optimum choice to differentiate nutritional status in CCP from a control group (Kuperminc et al 2010;Tomoum et al 2010;Omeroglu et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Serum Leptin as a Nutritional Biomarker in Children with Cerebral Palsy

Amarase

Weerasopone

Osateerakun

et al. 2016

Tohoku J. Exp. Med.

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Adequate nutrition is crucial for children with cerebral palsy (CCP). However, conventional nutritional assessments may be inadequate for defining undernourished CCP. Leptin, an adipocyte hormone controlling energy expenditure, could be a useful marker. Objectives of this cross-sectional analytic study were to explore correlations between serum leptin level and nutritional status, anthropometric measurements, and biochemical parameters in 86 CCP (aged 9 ± 2 years). Subscapular (SST) and triceps (TST) skinfold thicknesses, weight, and calculated height were obtained. Body mass index and weight-forheight (WH) Z-scores were calculated. Complete blood count and serum levels of leptin and albumin were collected. CCP were classified as undernourished if their WHZ was < −2 according to the World Health Organization criteria. Correlations between anthropometric measurements, biochemical data, and serum leptin levels were evaluated. From 86 CCP, 11 (12%) children were undernourished, and SST, hemoglobin, and hematocrit were significantly lower. Serum leptin levels of nourished and undernourished CCP were 5.4 ± 6.2 and 2.9 ± 1.6 ng/mL (p < 0.001), while the reported value from normal children was 4.9 ng/mL. Serum leptin levels demonstrated a significant correlation with SST and TST (r = 0.83 and 0.72; p < 0.001). Serum leptin was the only marker significantly correlated with WHZ (r = 0.45, p < 0.001) while adjusting for covariates. A serum leptin level of 2.2 ng/mL was the optimal cutoff point for defining adequate nutritional status (WHZ ≥ −2). The measurement of serum leptin should be included in a care scheme of CCP especially during surgical evaluation.

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Superior Mesenteric Artery Syndrome Following Spinal Deformity Correction

Abstract: Preoperative identification of the risk factors described above in conjunction with preoperative nutritional maximization should be considered in order to limit the prevalence of superior mesenteric artery syndrome in patients undergoing surgical correction of spinal deformity.

Cited by 30 publications

References 18 publications

Superior mesenteric artery syndrome – A rare presentation and challenge in spinal cord injury rehabilitation: A case report and literature review

Superior mesenteric artery syndrome – A rare presentation and challenge in spinal cord injury rehabilitation: A case report and literature review

Perioperative concerns in pediatric patients undergoing different types of scoliosis correction surgery: A retrospective observational study

Serum Leptin as a Nutritional Biomarker in Children with Cerebral Palsy

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