CASE REPORT
A case report of a 13-year-old girl diagnosed with superior mesenteric artery syndrome after undergoing spine correction with posterior fusion for rapidly progressed juvenile idiopathic scoliosis
 
More details
Hide details
1
Department of Trauma and Orthopaedic, Regional Specialized Children's Hospital in Olsztyn, Poland
2
Department of General Surgery, Vascular Surgery and Transplantology, Regional Specialized Hospital in Olsztyn, Poland
3
Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
CORRESPONDING AUTHOR
Paweł Grabala   

Department of Trauma and Orthopaedic, Regional Specialized Children's Hospital, Żołnierska 18A, 10-561 Olsztyn, Poland. Tel.: +48 89 675 51 13/787 111 100; fax: +48 77 546 63 24.
Submission date: 2016-01-18
Acceptance date: 2016-02-23
Online publication date: 2016-03-16
Publication date: 2020-03-24
 
Pol. Ann. Med. 2016;23(2):165–171
 
KEYWORDS
ABSTRACT
Introduction:
Superior mesenteric artery (SMA) syndrome (SMAS) is a relatively rare disease that the etiology is closely related to the anatomy and the topography of the duodenum, aorta, and SMA.

Aim:
To present and analyze the case of a patient who was diagnosed and treated for SMAS after scoliosis surgery.

Case study:
A 13-year-old girl was admitted to our department for the surgical treatment of juvenile idiopathic scoliosis, with a Cobb angle of 1208 in the main curvature. Postoperatively, we obtained the expected correction of 50%. Interestingly, after the treatment, BMI changed from 19 to 16, which assigned the patient to the underweight, starvation and emaciation group.

Results and discussion:
On the 5th postoperative day, the patient's condition deteriorated. She suffered from abdominal pain, nausea and vomiting. We diagnosed SMAS. After conservative treatment the patient's condition improves and she was discharged from the hospital on the 16th postoperative day in a good general condition after the complete resolution of SMAS symptoms.

Conclusions:
(1) SMAS can occur frequently in patients after surgical correction of the spine deformities. (2) At the curvatures of the order of 1008–1208 or more, there is a significant change in the topography of the anatomical structures and their adaptation to a new position after surgery. (3) Special attention must be paid to young, lean patients, with BMI below 19, and the postoperative effect of an elongated axis of the spine. (4) Even if SMAS occurs, in most cases it can and should be treated conservatively.

CONFLICT OF INTEREST
None declared.
FUNDING
This work was financed by own funds of all authors.
 
REFERENCES (34)
1.
Horn PL, Beeb AC, King DR. A rare cause of postoperative abdominal pain in a spinal fusion patient. Am J Orthop (Belle Mead NJ). 2015;44(9):350–354.
 
2.
Kim JY, Kim HS, Moon ES, et al. Incidence and risk factors associated with superior mesenteric artery syndrome following surgical correction of scoliosis. Asian Spine J. 2008;2(1):27–33.
 
3.
Beltrán OD, Martinez AV, Manrique Mdel C, Rodríguez JS, Febres EL, Peña SR. Superior mesenteric artery syndrome in a patient with Charcot Marie Tooth disease. World J Gastrointest Surg. 2011;3(12):197–200.
 
4.
von Rokitansky C. Handbuch der Pathologischen Anatomie. Vienna: Braumüller & Seidel; 1842.
 
5.
Lam D, Lee JZJ, Chua J, Lee YT, Lim KBL. Superior mesenteric artery syndrome following surgery for adolescent idiopathic scoliosis: a case series, review of the literature, and an algorithm for management. J Paediat Orthop Part B. 2014;23(4):312–318.
 
6.
Zhu ZZ, Qiu Y. Superior mesentric artery syndrome following scoliosis surgery: its risk indicators and treatment strategy. World J Gastroenterol. 2005;11(21):3307–3310.
 
7.
Gustafsson L, Falk A, Lukes PJ, Gamklou R. Diagnosis and treatment of superior mesenteric artery syndrome. Br J Surg. 1984;71(7):499–501.
 
8.
Pan CH, Tzeng ST, Chen CS, Chen PQ. Superior mesenteric artery syndrome complicating staged corrective surgery for scoliosis. J Formos Med Assoc. 2007;106(2 Suppl):S37–S45.
 
9.
Okugawa Y, Inoue M, Uchida K, et al. Superior mesenteric artery syndrome in an infant: case report and literature review. J Pediatr Surg. 2007;42(10):E5–E8.
 
10.
de Koning TJ, van Schie C, Waelkens JJ. Acute gastric dilatation and superior mesenteric artery syndrome in mentally retarded patients. Ned Tijdschr Geneeskd. 1996;140(39):1960–1963 [in Dutch].
 
11.
Arthurs OJ, Mehta U, Set PA. Nutcracker and SMA syndromes: what is the normal SMA angle in children? Eur J Radiol. 2012;81(8):e854–e861.
 
12.
Shah MA, Albright MB, Vogt MT, Moreland MS. Superior mesenteric artery syndrome in scoliosis surgery: weight percentile for height as an indicator of risk. J Pediatr Orthop. 2003;23(5):665–668.
 
13.
Kingham TP, Shen R, Ren C. Laparoscopic treatment of superior mesenteric artery syndrome. JSLS. 2004;8(4):376–379.
 
14.
Kowalski IM, Dwornik M, Lewandowski R, et al. Early detection of idiopathic scoliosis – analysis of tree screening models. Arch Med Sci. 2015;11(5):1058–1064.
 
15.
Kowalski IM, Protasiewicz-Fałdowska H, Dwornik M, Pierożyński B, Raistenskis J, Kiebzak W. Objective parallelforms reliability assessment of 3 dimension real time body posture screening tests. BMC Pediatr. 2014;14:221–228.
 
16.
Wang Y, Xie J, Zhao Z, et al. Preoperative short-term traction prior to posterior vertebral column resection: procedure and role. Eur Spine J. 2015;25(3):687–697.
 
17.
Kulkarni AG, Shah SP. Intraoperative skull-femoral (skeletal) traction in surgical correction of severe scoliosis (>808) in adult neglected scoliosis. Spine (Phila Pa 1976). 2013;38(8):659–664.
 
18.
Nepple JJ, Lenke LG. Severe idiopathic scoliosis with respiratory insufficiency treated with preoperative traction and staged anteroposterior spinal fusion with a 2-level apical vertebrectomy. Spine J. 2009;9(7):e9–e13.
 
19.
Altiok H, Lubicky JP, DeWald CJ, Herman JE. The superior mesenteric artery syndrome in patients with spinal deformity. Spine (Phila Pa 1976). 2005;30(19):2164–2170.
 
20.
Welsch T, Büchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg. 2007;24(3):149–156.
 
21.
Carbó AI, Sangster G, Gates T, D'Agostino H. Role of imaging in the diagnosis of the superior mesenteric artery syndrome. J La State Med Soc. 2006;158(1):31–33.
 
22.
Applegate GR, Cohen AJ. Dynamic CT in superior mesenteric artery syndrome. J Comput Assist Tomogr. 1988;12(6):976–980.
 
23.
Barnes JB, Lee M. Superior mesenteric artery syndrome in all intravenous drug abuser after rapid weight loss. South Med J. 1996;89(3):331–334.
 
24.
Kowalski IM, Protasiewicz-Fałdowska H, Siwik P, et al. Analysis of the sagittal plane in standing and sitting position in girls with left lumbar idiopathic scoliosis. Pol Ann Med. 2013;20(1):30–34.
 
25.
Kowalski IM, Protasiewicz-Fałdowska H. Trunk measurements in the standing and sitting posture according to Evidence Based Medicine (EBM). J Spine Surg. 2013;1(5):66–79.
 
26.
Kowalski IM, Kotwicki T, Siwik P. Analysis of diagnostic methods in trunk deformities in the developmental age. Pol Ann Med. 2013;20(1):43–50.
 
27.
Crowther MAA, Webb PJ, Eyre-Brook IA. Superior mesenteric artery syndrome following surgery for scoliosis. Spine (Phila Pa 1976). 2002;27(24):E528–E533.
 
28.
Wyten R, Kelty CJ, Falk GL. Laparoscopic duodenojejunostomy for the treatment of superior mesenteric artery (SMA) syndrome: case series. J Laparoendosc Adv Surg Tech A. 2010;20(2):173–176.
 
29.
Rod J, Sarnacki S, Petit T, Ravasse P. Portal venous gas and thrombosis complicating superior mesenteric artery syndrome (Wilkie's syndrome) in a child. J Pediatr Surg. 2010;45(4):826–829.
 
30.
Lee TH, Lee JS, Jo Y, et al. Superior mesenteric artery syndrome: where do we stand today? J Gastrointest Surg. 2012;16(12):2203–2211.
 
31.
Tsirikos AI, Anakwe RE, Baker AD. Late presentation of superior mesenteric artery syndrome following scoliosis surgery: a case report. J Med Case Rep. 2008;2:9.
 
32.
Zabrowska-Sapeta K, Kowalski IM, Protasiewicz-Fałdowska H, Wolska O. Evaluation of the effectiveness of Chêneau brace treatment for idiopathic scoliosis – own observations. Pol Ann Med. 2010;17(1):44–53.
 
33.
Weiss HR, Werkmann M. Rate of surgery in patients treated with a Chêneau light brace using the SRS inclusion criteria. Pol Ann Med. 2012;9(1):1–8.
 
34.
Hod-Feins R, Copeliovitch L, Abu-Kishk I, et al. Superior mesenteric artery after scoliosis repair surgery: a case study and reassessment of the syndrome's pathogenesis. J Pediatr Orthop B. 2007;16(5):345–349.