The acute surgical abdomen following Kyphoscoliosis corrective surgery

Delayed presentation of Wilkie's syndrome after scoliotic curve correction surgery: a case report

BACKGROUND

Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare but serious complication following scoliosis correction surgery. It occurs as a result of mechanical compression of third part of duodenum between the SMA and aorta. This condition occurs most commonly in significantly underweight patients with deformities, and usually during the first week following spinal deformity corrective surgeries. The angle between the abdominal aorta and the SMA gets reduced following spinal lengthening during deformity correction surgery causing compression of third part of duodenum resulting in development of SMA syndrome.

CASE PRESENTATION

We present a case of 17-year-old male with congenital scoliosis with a 70-degree scoliotic curve who underwent spinal deformity correction surgery with posterior instrumented fusion. Post-operative course was uneventful and the patient was discharged after suture removal on post-operative day 15. The patient presented after 21-days of symptom onset on post-operative-day 51, with a 3 week history of post-prandial vomiting, abdominal pain and distension which resulted in rapid weight loss of 11 kg. A CT-angiogram showed obstruction at third part of duodenum. After reviewing clinical and radiological profile of the patient, a diagnosis of SMA syndrome was made. Conservative management was tried, but due to rapid deterioration of patient condition and symptoms of complete intestinal obstruction, the patient was treated surgically by gastro-jejunostomy and side-to-side jejuno-jejunostomy, which improved his condition.

CONCLUSION

SMA syndrome can occur much later than previously reported cases and with potentially life-threatening symptoms following scoliosis correction. Having a high index of suspicion, early recognition of condition and institution of appropriate treatment are essential to prevent occurrence of severe complications including risk of intestinal perforation and mortality. This case highlights management of delayed onset of SMA syndrome, with presentation further delayed after symptom onset, as is common in developing parts of the world, due to limited availability and accessibility of resources, and low socio-economic status of large segments of the population.

Superior Mesenteric Artery Syndrome Following Scoliosis Surgery: A Systematic Review of Case Reports

BACKGROUND

Superior mesenteric artery (SMA) syndrome is a well-recognized, rare complication of undergoing surgical correction of a spinal deformity. The objective of this study was to summarize the best available evidence on SMA syndrome treatment after scoliosis surgery. To identify differences, special attention was paid to scoliosis pathology, intervention and SMA syndrome presentation.

METHODS

A systematic review of the literature was performed on SMA syndrome following scoliosis surgery. The Web of Science, PubMed, Wanfang (Chinese) and EMBASE databases were systematically searched for articles from January 1971 to October 2020. The main subjects discussed are scoliosis pathology, intervention and SMA syndrome presentation.

RESULTS

A total of 32 articles with 52 cases were included in our report. The mean age of patients with SMA syndrome following scoliosis surgery was 14.7 ± 2.9 years and the majority (n = 42, 80.8%) were girls. The most frequently reported scoliosis type was adolescent idiopathic scoliosis (n = 34, 65.4%). The mean postoperative days (POD) (interval between the surgical treatment and the onset of symptoms) was 9.6 ± 9.5 days. Different treatment methods were analyzed in 46 patients. We noted a trend toward a higher percentage of patients with POD < 48 hr in the group with surgical treatment than in the conservative treatment group (P = 0.002).

CONCLUSION

In summary, in this systematic review, for the first time, we found that the time of onset of postoperative symptoms can be used as an important reference index for surgical intervention. We also believe that recommendations about the treatment of SMA syndrome following scoliosis surgery should include this finding. Given the lack of robust clinical evidence, these findings warrant verification in a prospective multicenter screening trial.

Acute celiac artery compression syndrome after surgical correction of Scheuermann kyphosis

STUDY DESIGN

A case of acute celiac artery compression syndrome after spinal fusion in a patient with Scheuermann kyphosis is reported.

OBJECTIVE

To describe the unusual complication of acute celiac artery compression after surgical kyphosis correction, to outline diagnostic methods, and to review the pertinent literature.

SUMMARY OF BACKGROUND DATA

Chronic celiac artery compression syndrome is well described, yet there is only 1 reported case of acute celiac artery compression after surgical correction of kyphosis. There have been no previous reports of this complication leading to foregut ischemic necrosis after correction of Scheuermann kyphosis.

METHODS

Case report and literature review.

RESULTS

After an anterior release and posterior spinal fusion for a 106 degrees kyphotic deformity performed under 1 anesthetic, our patient developed a perforated gastric antrum on postoperative day 5, evolving to ischemic necrosis of the stomach, gallbladder, and spleen discovered on postoperative day 7. Abdominal angiography indicated that his celiac artery had been occluded at its origin. After this event, the patient required a prolonged intensive care hospital stay and required a Roux-en-Y gastro-jejeunostomy reconstruction. He is now doing well at 1-year follow-up with independent ambulation and a regular diet.

CONCLUSION

Acute celiac artery compression after surgical kyphosis correction is a rare but potentially serious adverse event. Spinal deformity surgeons and intensivists should be aware of this entity, and should have a high index of suspicion for it if sepsis of unknown origin, an acute abdomen, or elevated liver enzymes are encountered after surgery after correction of a kyphotic deformity.