Superior mesenteric artery syndrome following spinal deformity correction

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Abstract

Background. Superior mesenteric artery syndrome is a rare pathological condition caused by an abnormal transposition of the superior mesenteric artery from the abdominal part of the aorta. It results in compression of the distal part of the duodenum between the aorta and the superior mesenteric artery. It is clinically manifested by signs of acute intestinal obstruction, including pain in the epigastric region, nausea, and profuse vomiting. In the absence of timely treatment, patients may experience electrolyte disturbance, severe nutritional deficiency, the risk of perforation of the stomach, aspiration pneumonia, bezoar formation, thromboembolism, and the development of other life-threatening complications that can lead to death.

Case study. In the presented case study, superior mesenteric artery syndrome developed in a 17-year-old girl after surgical correction of a spinal deformity in the treatment of idiopathic scoliosis. This was due to postoperative loss of body weight, as well as a rapid change in the patient’s ratio of growth to body weight.

Discussion. Significant clinical improvement was achieved as a result of an integrated approach to the treatment of this complication. However, despite the successful result from conservative therapy, the patient remains at risk of developing chronic duodenal obstruction of varying severity, which may require surgical treatment.

Conclusion. With the untimely and incomplete treatment of superior mesenteric artery syndrome, the risk of developing chronic intestinal obstruction increases. Treatment of this complication begins with conservative therapy. In the absence of the effect of conservative therapy, and in the case of disease progression, the development of life-threatening conditions (such as bleeding and perforation) requires surgical treatment.

About the authors

Angelina S. Strelnikova

The Turner Scientific Research Institute for Children’s Orthopedics

Author for correspondence.
Email: angelina.str.93@gmail.com
ORCID iD: 0000-0003-2013-1553

MD, Anesthesiologist-Intensivist, Department of Anesthesiology, Resuscitation and Intensive Care

Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Aleksandr S. Kozyrev

The Turner Scientific Research Institute for Children’s Orthopedics

Email: alexkozirev@inbox.ru
ORCID iD: 0000-0002-2828-4063

MD, PhD, Chief Doctor, Anesthesiologist-Intensivist of the Department of Anesthesiology, Resuscitation and Intensive Care

Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Sergei V. Vissarionov

The Turner Scientific Research Institute for Children’s Orthopedics

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048

MD, PhD, D.Sc., Professor, Correspondent Member of RAS, Deputy Director for Research and Academic Affairs, Head of the Department of Spinal Pathology and Neurosurgery

Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Kirill A. Kartavenko

The Turner Scientific Research Institute for Children’s Orthopedics

Email: med-kart@yandex.ru
ORCID iD: 0000-0002-6112-3309

MD, PhD, Orthopedic and Trauma Surgeon of the Department of Spinal Pathology and Neurosurgery

Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Vladislav V. Murashko

The Turner Scientific Research Institute for Children’s Orthopedics

Email: v.murashko@gmail.com
ORCID iD: 0000-0002-2201-6906

MD, Orthopedic and Trauma Surgeon of the Department of Spinal Pathology and Neurosurgery

Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

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Supplementary files

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2. Fig. 1. X-ray of the spine in a frontal view in a standing position

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3. Fig. 2. X-ray of the spine in a lateral view in a standing position

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4. Fig. 3. Radiograph of abdominal organs with oral administration of a contrast agent

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5. Fig. 4. X-ray of the abdominal organs with the introduction of contrast through the duodenal probe

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6. Fig. 5. Repeated X-ray of the abdominal organs

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7. Fig. 6. Combined multispiral computed tomography with contrasting of the gastrointestinal tract and angiography of the vessels of the abdominal cavity: 1 — aorta; 2 — superior mesenteric artery

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8. Fig. 7. Control computed tomography: 1 — aorta; 2 — superior mesenteric artery

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Copyright (c) 2020 Strelnikova A.S., Kozyrev A.S., Vissarionov S.V., Kartavenko K.A., Murashko V.V.

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