Neglected severe rigid scoliosis with postoperative superior mesenteric artery syndrome: A case report

A 14-year-old adolescent male with global developmental delay presented with neglected severe rigid scoliosis, with thoracic Cobb angle 101.6° and lumbar curve of 59.4°. His body mass index (BMI) was 15.2 kg/m², reflecting undernutrition. Staged correction with anterior release followed by posterior instrumented fusion and Ponte osteotomies achieved significant deformity correction. Postoperatively, the patient developed superior mesenteric artery (SMA) syndrome, confirmed on CT angiography showing duodenal compression by the SMA. He was managed conservatively with nasogastric aspiration and nil per oral (NPO) for four days, followed by gradual reintroduction of liquids over 2-3 days, and later solids. SMA syndrome is a rare but recognized complication after scoliosis correction, attributed to acute change in spinal alignment and reduction of mesenteric fat pad leading to duodenal compression. Conservative measures including NPO, nasogastric decompression, fluid and electrolyte balance, and gradual oral intake remain first-line management, with surgery reserved for refractory cases. At six-year follow-up, the patient had sustained good clinical and radiological correction.