Unusual delayed presentation of superior mesenteric artery syndrome following scoliosis correction surgery-a case report and review of literature

Abstract

Superior mesenteric artery (SMA) syndrome secondary to extrinsic compression of third part of duodenum is an uncommon complication following scoliosis surgery. It is imperative to diagnose this presentation at an earlier stage as it can be a potentially life threatening complication. If the diagnosis is missed or delayed, the mortality rate can be as high as 33% due to fatal complications like aspiration pneumonia, acute gastric rupture and cardiovascular collapse. We present a 13-year-old patient who was diagnosed with SMA syndrome in the late post-operative period (5.1 weeks) following scoliosis correction surgery. A barium meal and follow-through confirmed the diagnosis of SMA syndrome. She was managed conservatively with which she recovered uneventfully. Such late presentations are very uncommon. In addition, we have also briefly reviewed the pertinent literature. It is essential that we identify high risk patients preoperatively so that we could optimize them with proper intensive dietary supplementation. Postoperatively, a high index of suspicion needs to be retained to identify this syndrome at an early stage so that conservative management may be initiated with good clinical outcome. SMA syndrome can be potentially life threatening when the diagnosis is missed or delayed.

Keywords: Superior mesenteric artery (SMA); delayed; presentation; scoliosis; syndrome.

Figure 1

Preoperative radiographs (posteroanterior & lateral) with right and left bending films.

Figure 2

Postoperative radiographs following posterior spinal instrumentation and fusion (T3–L4).

Figure 3

Barium meal and follow-through films demonstrating dilatation and stasis of contrast in third segment of duodenum (D3).