Superior Mesenteric Artery Syndrome as a Complication of Scoliosis Surgery

Abstract

Superior mesenteric artery (SMA) syndrome is a rare and potentially life-threatening complication of scoliosis surgery. The anatomical relationship of the duodenum and the superior mesenteric artery, the correction of angular deformity of the spine, and the normal adolescent growth spurt all contribute to the condition. We report the case of a 14-year-old boy who had a history of idiopathic scoliosis and presented with bilious vomiting that had persisted for 7 days after posterior T9-L4 fusion with instrumentation. After an unremarkable immediate postoperative course, on postoperative day 19 the patient presented to the emergency department with abdominal pain, nausea, and vomiting. Unrelenting brown vomitus, abdominal pain, and a 20-lb weight loss were noted. A series of upper gastrointestinal radiographs confirmed a diagnosis of SMA syndrome. A nasojejunal tube was placed, and nutritional rehabilitation was optimized. We highlight this case for its rarity and emphasize the importance of maintaining a high index of suspicion when evaluating a child who has had spinal deformity correction and presents with postoperative gastrointestinal complaints. Early recognition of the nonspecific symptoms of abdominal pain, abdominal distension, bilious or projectile vomiting, hypoactive bowel sounds, and anorexia plays a key role in post-scoliosis surgery and is crucial in preventing the severe morbidity and mortality associated with SMA syndrome.