Superior mesenteric artery syndrome in pediatric orthopedic patients

Superior mesenteric artery (SMA) syndrome is a rare cause of small bowel obstruction in both adult and pediatric populations. Of 14 patients with the diagnosis from 1979 to 1987, eight had confirmatory upper gastrointestinal studies and were able to be followed for an average of 32 months. All eight were of similar age (range, 14.2 to 19 years), body build (asthenic), and clinical presentation. The presentation included nausea and intermittent, voluminous, bile-stained vomiting, despite intervening periods of normal appetite and bowel sounds. The average delay in diagnosis was five days. Nasogastric drainage and intravenous fluids were the mainstay of treatment and were successful in every case. Fifty percent of the patients had more than one episode requiring treatment; each episode resolved with simple treatment. Two of three patients with body casts required cast removal. No patient required intravenous hyperalimentation, removal of spinal instrumentation, or abdominal surgery to relieve the obstruction. Three of the eight patients had not had spinal surgery or cast immobilization.