Maharajan Karthikeyan, Thambiah Joseph Shanthakumar
University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore 119074, Singapore.
J Spine Surg. 2017 Jun;3(2):272-277. doi: 10.21037/jss.2017.06.09.
Superior mesenteric artery (SMA) syndrome secondary to extrinsic compression of third part of duodenum is an uncommon complication following scoliosis surgery. It is imperative to diagnose this presentation at an earlier stage as it can be a potentially life threatening complication. If the diagnosis is missed or delayed, the mortality rate can be as high as 33% due to fatal complications like aspiration pneumonia, acute gastric rupture and cardiovascular collapse. We present a 13-year-old patient who was diagnosed with SMA syndrome in the late post-operative period (5.1 weeks) following scoliosis correction surgery. A barium meal and follow-through confirmed the diagnosis of SMA syndrome. She was managed conservatively with which she recovered uneventfully. Such late presentations are very uncommon. In addition, we have also briefly reviewed the pertinent literature. It is essential that we identify high risk patients preoperatively so that we could optimize them with proper intensive dietary supplementation. Postoperatively, a high index of suspicion needs to be retained to identify this syndrome at an early stage so that conservative management may be initiated with good clinical outcome. SMA syndrome can be potentially life threatening when the diagnosis is missed or delayed.
十二指肠第三部受外部压迫继发的肠系膜上动脉（SMA）综合征是脊柱侧弯手术后一种罕见的并发症。必须在早期阶段诊断出这种表现，因为它可能是一种潜在的危及生命的并发症。如果漏诊或延误诊断，由于吸入性肺炎、急性胃破裂和心血管衰竭等致命并发症，死亡率可能高达33%。我们报告一名13岁患者，在脊柱侧弯矫正手术后的术后晚期（5.1周）被诊断为SMA综合征。钡餐造影及随访证实了SMA综合征的诊断。她接受了保守治疗，最终顺利康复。如此晚期的表现非常罕见。此外，我们还简要回顾了相关文献。我们必须在术前识别出高危患者，以便通过适当的强化饮食补充对他们进行优化。术后，需要保持高度的怀疑指数，以便在早期阶段识别出该综合征，从而启动保守治疗并获得良好的临床结果。如果漏诊或延误诊断，SMA综合征可能会危及生命。
