Superior mesenteric artery syndrome in a young girl following spinal surgery for scoliosis.

A 15-year-old girl was admitted with nausea, severe bilious vomiting, loss of appetite and loss of weight of 2 weeks' duration. She underwent spinal surgery for thoracic scoliosis with multiple congenital abnormalities of the spine 3 weeks before admission. Examination revealed a thin, dehydrated patient with distended upper abdomen, positive succussion splash and normal bowel sounds. Blood investigations including urea and electrolytes were normal except for mild leucocytosis. Abdominal X-ray was unremarkable. A nasogastric tube was inserted which drained 2–3 litres of bilious fluid each day. She was treated conservatively with intravenous fluids and anti-emetics. The history of spinal surgery and copious amount of bilious nasogastric aspirate suggested upper gastrointestinal obstruction for which a barium meal with follow through was done on day 3 (Figures 1 and 2). It revealed a distended stomach and dilatation of the first and second parts of the duodenum with an abrupt linear cut-off at the third par...