Abdominal Pain after Spine Surgery
A
14-year-old girl with Marfan syndrome underwent thoracolumbar posterior spine arthrodesis for correction of severe scoliosis. Eight days after surgery she presented with acute and intense abdominal pain and underwent conventional abdominal radiographs that showed severe gastric distension and distension of part of the small intestine (Figure). Contrast enhanced computed tomography of the abdomen confirmed distension of the stomach and of the duodenum that reached the right iliac fossa. Computed tomography also showed focal duodenal stenosis between the aorta and the superior mesenteric artery (SMA). This imaging confirmed the diagnosis of SMA syndrome.1 SMA syndrome is a rare clinical condition characterized by symptoms of small intestine obstruction such as nausea,
vomiting, abdominal pain (especially postprandial pain), and bloating. The duodenal obstruction is caused by external compression of the intervening portion of duodenum between the SMA and abdominal aorta.1,2 This syndrome could occur as a postoperative complication after spine surgery as in this case or could be due to prolonged confinement in the supine position, rapid growth in height, rapid loss of weight, and severe burns. Females and young adults are more frequently affected.3 Treatment options include both conservative and surgical strategies, such as laparoscopic duodenojejunostomy.4 n Paolo Spinnato, MD Alberto Bazzocchi, MD, PhD Ugo Albisinni, MD Diagnostic and Interventional Radiology Rizzoli Orthopaedic Institute Bologna, Italy
References 1. Yakan S, Caliskan C, Kaplan H, Denecli AG, Coker A. Superior mesenteric artery syndrome: a rare cause of intestinal obstruction. Diagnosis and surgical management. Indian J Surg 2013;75:106-10. 2. Welsch T, Buchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg 2007;24:149-56. 3. Kim S, Kim YS, Min YD. SMA syndrome treated by single incision laparoscopic duodenojejunostomy. Clin Med Insights Case Rep 2014;7:87-9. 4. Pottorf BJ, Husain FA, Hollis HW Jr, Lin E. Laparoscopic management of duodenal obstruction resulting from superior mesenteric artery syndrome. JAMA Surg 2014;149:1319-22.
Figure. Conventional abdominal radiograph (lateral projection) showed abnormal distension of the stomach and part of small bowel.
J Pediatr 2015;166:1095. 0022-3476/$ - see front matter. Copyright ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2014.12.055
1095
A
14-year-old girl with Marfan syndrome underwent thoracolumbar posterior spine arthrodesis for correction of severe scoliosis. Eight days after surgery she presented with acute and intense abdominal pain and underwent conventional abdominal radiographs that showed severe gastric distension and distension of part of the small intestine (Figure). Contrast enhanced computed tomography of the abdomen confirmed distension of the stomach and of the duodenum that reached the right iliac fossa. Computed tomography also showed focal duodenal stenosis between the aorta and the superior mesenteric artery (SMA). This imaging confirmed the diagnosis of SMA syndrome.1 SMA syndrome is a rare clinical condition characterized by symptoms of small intestine obstruction such as nausea,
vomiting, abdominal pain (especially postprandial pain), and bloating. The duodenal obstruction is caused by external compression of the intervening portion of duodenum between the SMA and abdominal aorta.1,2 This syndrome could occur as a postoperative complication after spine surgery as in this case or could be due to prolonged confinement in the supine position, rapid growth in height, rapid loss of weight, and severe burns. Females and young adults are more frequently affected.3 Treatment options include both conservative and surgical strategies, such as laparoscopic duodenojejunostomy.4 n Paolo Spinnato, MD Alberto Bazzocchi, MD, PhD Ugo Albisinni, MD Diagnostic and Interventional Radiology Rizzoli Orthopaedic Institute Bologna, Italy
References 1. Yakan S, Caliskan C, Kaplan H, Denecli AG, Coker A. Superior mesenteric artery syndrome: a rare cause of intestinal obstruction. Diagnosis and surgical management. Indian J Surg 2013;75:106-10. 2. Welsch T, Buchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg 2007;24:149-56. 3. Kim S, Kim YS, Min YD. SMA syndrome treated by single incision laparoscopic duodenojejunostomy. Clin Med Insights Case Rep 2014;7:87-9. 4. Pottorf BJ, Husain FA, Hollis HW Jr, Lin E. Laparoscopic management of duodenal obstruction resulting from superior mesenteric artery syndrome. JAMA Surg 2014;149:1319-22.
Figure. Conventional abdominal radiograph (lateral projection) showed abnormal distension of the stomach and part of small bowel.
J Pediatr 2015;166:1095. 0022-3476/$ - see front matter. Copyright ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2014.12.055
1095
