Background. Obstruction of the third part of the duodenum can occur because of the superior mesenteric artery syndrome (SMAS) after surgical correction of scoliosis. It is essential to evaluate risk factors and diagnose SMAS on time because complications of this condition are life-threatening and it is associated with high rate of morbidity. Diagnostic of 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 diagnose easier we present a rare clinical case of superior mesenteric artery syndrome after surgical correction of neuromuscular scoliosis.
Clinical case. 12 year-old girl with specific development disorder, sensory neuropathy and progressive kyphoscoliosis was admitted to Vilnius University Children Hospital. The patient had right side 50 degrees thoracic scoliosis and an 80 degrees thoracic kyphosis. She underwent posterior spinal fusion with hooks and screws from Th1 to L2. The fourth day after the surgery the patient developed nausea and began to vomit each day 1-2 times per day, especially after meals. SMAS was suspected and nasogastric tube was inserted, stomach decompression and the correction of electrolytes imbalance were made. After the treatment, symptoms did not recur and satisfactory correction and balance of the spine was made in coronal and sagittal planes.
Conclusions. It is extremely important to identify the risk factors of SMAS and begin preoperative diet supplements before surgical scoliosis correction for patients with low body mass index. After the first episode of vomiting after the surgery, we recommend to investigate these patients for gastrointestinal obstruction as soon as possible. Decompression of the stomach, enteral or parenteral nutrition, fluid therapy are essential in treating SMAS.