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Superior mesenteric artery syndrome in children and adolescents with spine deformities undergoing corrective surgery
Athanasios I Tsirikos1, Lindsay A Jeans
1Scottish National Spine Deformity Center, Royal Hospital for Sick Children, Edinburgh, UK. atsirikos@hotmail.com
Objective:
Obstruction of the third part of the duodenum by the superior mesenteric artery (SMA) is associated with spinal manipulation in the surgical or conservative management of scoliosis. The purpose of the present study was to investigate the prevalence of SMA syndrome in a cohort of 165 consecutive pediatric patients who underwent spine deformity surgery and had minimum 2-year follow-up.
Methods:
The study group comprised 85 patients with idiopathic scoliosis, 20 patients with neuromuscular and 18 patients with miscellaneous or syndromic scoliosis, and 42 patients with congenital spine deformities. Posterior spine arthrodesis was performed in 94 patients, combined anteroposterior in 60 patients, and anterior spinal fusion in 11 patients.
Results:
We identified four patients who developed SMA syndrome postoperatively. These were all markedly underweight adolescent girls; two patients had adolescent idiopathic scoliosis, one had neuromuscular scoliosis, and one congenital scoliosis. Third-generation instrumentation systems with derotational effect were used in three patients. The spine arthrodesis in the patient with neuromuscular scoliosis was performed using bone graft followed by application of a spinal jacket. The symptoms developed at a mean of 3.7 days post surgery and included nausea, vomiting, increased nasogastric aspirates, and abdominal pain and distension. Conservative management with prolonged nasojejunal feedings achieved resolution of the symptoms in all but one patient, who required derotation of the duodenum and jejunum. There was no evidence of recurrence of the condition in any patient. The prevalence of SMA syndrome in our series was 2.4%.
Conclusions:
This work draws attention to the significance of the prevention of the condition by recognizing patients who are at a higher risk. An early diagnosis of SMA syndrome will allow for application of conservative methods and will increase the chances for a successful outcome.