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2016 ; 23
(3
): 155-164
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Superior mesenteric artery syndrome
#MMPMID28356803
Bernotavi?ius G
; Saniukas K
; Karmonait? I
; Zagorskis R
Acta Med Litu
2016[]; 23
(3
): 155-164
PMID28356803
show ga
BACKGROUND: An obstruction of the distal part of the duodenum can occur because
of the superior mesenteric artery syndrome (SMAS) after a surgical correction of
scoliosis. It is essential to evaluate the risk factors and diagnose the SMAS in
time because complications of this condition are life-threatening and it is
associated with a high rate of morbidity. Diagnostics of the SMAS is challenging,
because it is rare and its symptoms are non-specific. Therefore, in order to
better understand the essence of this pathology and to make diagnosis easier we
present a rare clinical case of the superior mesenteric artery syndrome after a
surgical correction of neuromuscular scoliosis. THE CLINICAL CASE: A 12-year-old
girl with a specific development disorder, sensory neuropathy and progressive
kypho-scoliosis was admitted to Vilnius University Children's Hospital. The
patient had right side 50-degree thoracic scoliosis and an 80-degree thoracic
kyphosis. She underwent posterior spinal fusion with hooks and screws from Th1 to
L2. On the fourth day after the surgery the patient developed nausea and began to
vomit each day 1-2 times per day, especially after meals. The SMAS was suspected
and a nasogastric tube was inserted, stomach decompression and the correction of
electrolytes disbalance were made. After the treatment, the symptoms did not
recur and a satisfactory correction and balance of the spine were made in coronal
and sagittal planes. CONCLUSIONS: It is extremely important to identify the risk
factors of the SMAS and begin preoperative diet supplements before surgical
correction of scoliosis for patients with a low body mass index. After the first
episode of vomiting following the surgery, we recommend to investigate these
patients for a gastrointestinal obstruction as soon as possible. Decompression of
the stomach, enteral or parenteral nutrition, and fluid therapy are essential in
treating the SMAS.
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