Late-onset superior mesenteric artery syndrome four years following scoliosis surgery – a case report

Abstract

Background: Superior mesenteric artery (SMA) syndrome has been reported as an uncommon condition of external vascular compression of the SMA particularly after rapid weight loss, body casts, or after corrective surgery for spinal deformities, usually within the first few weeks after surgery. Methods: This is a retrospective report of a case of a non-verbal autistic female patient who started to develop SMA syndrome at the age of 16, 4 years after posterior spinal fusion surgery for scoliosis. She was treated conservatively by increasing oral caloric intake, which resulted in increased body weight and relief of symptoms. Results: Seen at 10 years’ follow up, the patient is doing well, and is functional within the limits of her suboptimal cognitive and verbal conditions. She maintains good trunk balance with solid spinal fusion and intact instrumentation at latest follow up. Conclusion: Spinal surgeons should maintain a high index of suspicion for diagnosis of SMA syndrome even years after scoliosis surgery, especially for patients with communication problems, like the case we present here. Appropriate conservative measures can succeed in relieving the symptoms, increasing body weight, and preventing complications including the risk of death.

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

“…Symptoms of SMA syndrome usually occur after five to seven days of scoliosis surgery [ 5 , 6 , 13 , 14 , 16 ]. Patients often present with persistent bilious or non-bilious vomiting along with abdominal distension and epigastric tenderness.…”

“…Onset of SMA syndrome usually starts within 7 days of spinal deformity correction surgery, but late onset disease has been reported in literature ranging from several weeks to 4 years after scoliosis surgery [ 15 , 16 , 20 , 43 ]. Onset of symptoms in this case was late, started from post-operative day 30, and diagnosis of SMA syndrome was confirmed when radiological investigations were performed when at the time of presentation of the patient to our institute 3 weeks after symptom onset, on post-operative day 51.…”

What is causing this teen's abdominal pain and weight loss?

“…As a result, clinicians should consider SMAS in patients with a history of bariatric surgery 6. Clinicians also must consider this syndrome in patients who have had scoliosis corrective surgery; SMAS can occur days to years postoperatively 2,8. A patient's risk of SMAS increases after scoliosis corrective surgery because the patient's anatomy is altered by lengthening the vertebrae.…”

“…A patient's risk of SMAS increases after scoliosis corrective surgery because the patient's anatomy is altered by lengthening the vertebrae. This results in narrowing of the aortomesenteric angle and compression of the duodenum 8. Awareness of this condition prevents detrimental effects of an inaccurate diagnosis including hyperkalemia, hypocalcemia, cardiac dysrhythmias, kidney damage, duodenal perforation, and death 5,6.…”

“…This results in narrowing of the aortomesenteric angle and compression of the duodenum. 8 Awareness of this condition prevents detrimental effects of an inaccurate diagnosis including hyperkalemia, hypocalcemia, cardiac dysrhythmias, kidney damage, duodenal perforation, and death. 5,6 In fact, a delayed diagnosis increases the mortality to 33%, emphasizing the need for clinicians to recognize this condition promptly.…”