Traore Mamadou Mour, Leye Pape Alassane, Bah Mamadou Diawo, Kinkpe Charles Valérie Alain, Ndiaye Pape Ibrahima, Daffe Mohamed, Toure Alpha Omar, Kane Oumar
Centre Hospitalier de l'Ordre de Malte à Dakar, Sénégal.
Service d'Anesthésie - Réanimation CHU Aristide Le Dantec à Dakar, Sénégal.
Pan Afr Med J. 2016 Oct 17;25:90. doi: 10.11604/pamj.2016.25.90.8773. eCollection 2016.
Superior mesenteric artery syndrome is a rare complication occurring after surgical treatment for scoliosis. Surgical correction of the scoliotic spine produces vertical traction on the mesenteric artery and the narrowing of the aortomesenteric angle, hence the compression of the third part of the duodenum causing the syndrome. We here report the case of a young girl with an early form of superior mesenteric artery syndrome secondary to surgical correction of idiopathic scoliosis. The patient underwent posterior spinal fusion for idiopathic scoliosis. On the third postoperative day she experienced uncontrollable vomiting associated with no evacuation of faeces and no passing of flatus. Urgent abdominal CT scan was performed which allowed the diagnosis of superior mesenteric artery syndrome. Treatment consisted in the rest of the digestive tract associated with early parenteral nutrition and correction of fluid and electrolyte imbalances. Lacking evidence of clinical improvement, surgical indication was posed. The evolution was favourable with an uneventful postoperative recovery and the resumption of adequate food intake on the fourth postoperative day. The patient was discharged on the seventh postoperative day. Contributing factors are young age, long-limbed morphotype with BMI below 18. CT scan shows an important gastric dilatation associated with complete halt of the third part of the duodenum. The treatment is multidisciplinary, medical (first-line treatment) and surgical (if medical treatment do not help). A better knowledge of the predictors of medical treatment failure would reduce the length of hospital stay.
肠系膜上动脉综合征是脊柱侧弯手术治疗后罕见的并发症。脊柱侧弯的手术矫正会对肠系膜动脉产生垂直牵引，并使主动脉肠系膜角变窄，从而压迫十二指肠第三部导致该综合征。我们在此报告一例因特发性脊柱侧弯手术矫正继发早期肠系膜上动脉综合征的年轻女孩病例。该患者因特发性脊柱侧弯接受了后路脊柱融合术。术后第三天，她出现无法控制的呕吐，同时伴有无排便和无排气。紧急进行了腹部CT扫描，从而诊断出肠系膜上动脉综合征。治疗包括消化道休息、早期肠外营养以及纠正液体和电解质失衡。由于缺乏临床改善的证据，提出了手术指征。病情发展良好，术后恢复顺利，术后第四天恢复了充足的食物摄入。患者术后第七天出院。促成因素包括年轻、体型瘦长且体重指数低于18。CT扫描显示胃明显扩张，同时十二指肠第三部完全梗阻。治疗是多学科的，包括内科治疗（一线治疗）和外科治疗（如果内科治疗无效）。更好地了解内科治疗失败的预测因素将缩短住院时间。
