The acute surgical abdomen following Kyphoscoliosis corrective surgery

Abstract

In December 2003, a 14-year-old girl was referred via her GP with suspected appendicitis giving a 2-day history of colicky right sided abdominal pain and profuse vomiting. Her relevant past history included corrective scoliosis surgery for adolescent idiopathic scoliosis. An anterior spinal fusion T11-L3 and posterior spinal fusion T3-L3 had been performed 21 and 15 days previously, respectively. She had been discharged in a Scotchcast body cast. This surgery had been performed at a neurosurgical unit in another hospital.On examination, she was flushed, tachycardic at 115 beats/min and pyrexial at 38.2°C. Her abdomen was soft with moderate generalised tenderness throughout and percussion tenderness in the epigastric and RIF region. Diagnosis was uncertain at this point. Ultrasonography demonstrated a large, left upper quadrant, fluid-filled viscus extending from high in the left upper quadrant to the pelvis on the left side and then across the midline to the right. In addition, there was a loop of dilated small bowel in the right upper quadrant. As a result of the ultrasound scan, an abdominal and chest X-ray were performed (Fig. 1) showing a large stomach with a fluid level.

Acute celiac artery compression syndrome after extensive correction of sagittal balance on an adult spinal deformity

“…Changes to the anatomy of the abdominal vasculature after spinal deformity surgery have been well documented, with SMA syndrome being the most common manifestation [5][6][7]. SMA syndrome is comparatively benign and resolves with nasogastric suction and nutritional support.…”