title: A Rare Cause of Postoperative Abdominal Pain in a Spinal Fusion Patient.
abstract: We present the case of a 12-year-old girl who underwent an uncomplicated posterior spinal fusion with instrumentation for scoliosis and who later developed nausea, emesis, and abdominal pain. We discuss the epidemiology, prevalence, anatomic findings, symptoms, diagnostic tests, and clinical management, including nonsurgical and surgical therapies, of superior mesenteric artery syndrome (SMAS), a rare condition. Over a 2-week period, the patient developed an uncommon type of bowel obstruction likely related to her initial thin body habitus, correction of her deformity, and weight loss after surgery. The patient returned to the operating room for placement of a Stamm gastrostomy feeding tube with insertion of a transgastric-jejunal (G-J) feeding tube. The patient had the G-J feeding tube in place for approximately 6 weeks to augment her enteral nutrition. As she gained weight, her duodenal emptying improved, and she gradually transitioned to normal oral intake. She has done well since the G-J feeding tube was removed. Posterior spinal fusion for adolescent idiopathic scoliosis is a relatively common procedure, and SMAS is a rare condition. However, in the case of an asthenic adolescent with postoperative weight loss, intestinal obstruction can develop. When planning operative spinal correction in scoliosis patients who have a low body mass index at the time of surgery and who have increased thoracic stiffness, be alert for signs and symptoms of SMAS. This rare complication can develop, and timely diagnosis and medical management will decrease morbidity and shorten the length of time needed for nutritional rehabilitation.
authors.affiliation: Department of Orthopaedics, Nationwide Children's Hospital, Columbus, OH. pam.horn@nationwidechildrens.org.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Horn
authors.forename: Allan C
authors.initials: AC
authors.lastname: Beeb
authors.forename: Denis R
authors.initials: DR
authors.lastname: King
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D002648:Child; D005260:Female; D006801:Humans; D010149:Postoperative Pain / Q000209:etiology*; D011184:Postoperative Period; D012600:Scoliosis / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects*; D013478:Superior Mesenteric Artery Syndrome / Q000209:etiology*