Document Detail

Relief of superior mesenteric artery syndrome with correction of multiplanar spinal deformity by posterior spinal fusion.
MedLine Citation:
PMID:  20608618     Owner:  NLM     Status:  MEDLINE    
Superior mesenteric artery syndrome is obstruction of the third portion of the duodenum by compression between the abdominal aorta and superior mesenteric artery. Pediatric orthopedists are familiar with this entity, as the association between superior mesenteric artery syndrome and spinal fusion or body casting has been well established. However, patients with spinal deformities usually experience superior mesenteric artery syndrome after orthopedic intervention, with rates after corrective spinal surgery reported between 0.5% and 2.4%. Symptoms of superior mesenteric artery syndrome typically include nausea, bilious emesis, abdominal pain, early satiety, and anorexia. Initial treatment focuses on gastric decompression and maintaining euvolemia and electrolyte balance. The patient should receive enteral nutrition via nasojejunal tube or parenteral nutrition to allow for weight gain and subsequent resolution of the obstruction. The superior mesenteric artery takes off from the duodenum at an angle of 45 degrees to 60 degrees in normal individuals. The third portion of the duodenum is suspended between these vessels by the ligament of Treitz. Any variation in this relationship that decreases the arteriomesenteric angle may induce obstruction. Specifically, lumbar hyperextension or hyperlordosis can traction the mesentery and vessels. Only 2 cases of superior mesenteric artery syndrome in patients with sagittal plane spinal deformity have been described in the literature. In patients with concomitant superior mesenteric artery syndrome and spinal deformity, correction of the deformity may help alleviate the obstruction and result in faster recovery. The contribution of spinal column deformity to the arteriomesenteric angle should not be overlooked.
Geoffrey S Marecek; Katherine A Barsness; John F Sarwark
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-07-13
Journal Detail:
Title:  Orthopedics     Volume:  33     ISSN:  1938-2367     ISO Abbreviation:  Orthopedics     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-08     Completed Date:  2010-10-14     Revised Date:  2010-10-26    
Medline Journal Info:
Nlm Unique ID:  7806107     Medline TA:  Orthopedics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  519     Citation Subset:  IM    
Copyright Information:
Copyright 2010, SLACK Incorporated.
Department of Orthopedic Surgery, Northwestern University, 676 N Saint Clair St, Ste 1350, Chicago, IL 60611, USA.
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MeSH Terms
Enteral Nutrition
Postoperative Complications / etiology*,  therapy
Scoliosis / radiography,  surgery*
Spinal Fusion / adverse effects*,  methods
Superior Mesenteric Artery Syndrome / etiology*,  radiography,  therapy
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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