術後重度の上腸間膜動脈症候群を合併した高度側弯症の1例

A Severe Superior Mesenteric Artery Syndrome Following Scoliosis Surgery. Case Report

　脊柱変形手術後の上腸間膜動脈(SMA)症候群発生頻度は0.5～4.7％と報告されており，その危険因子として高度変形，低体重などが知られている．症例は22歳の男性で，消化管手術後のイレウスの既往を持つ高度側弯症に対して二期的矯正固定術を施行した結果，SMA症候群による重度のイレウスを合併し，消化管の観血的治療で改善した．多くの場合保存的に治癒するが，本症例のように消化管手術後イレウスの既往を有する場合，脊柱変形矯正手術により十二指腸閉塞を来す可能性がある．

　Superior mesenteric artery (SMA) syndrome is a rare complication following scoliosis surgery, and most patients recover after conservative treatment.　We report a case of persistent SMA syndrome following scoliosis surgery that eventually required surgical intervention.　A 22-year-old male came to our department with severe double thoracic scoliosis.　The patient had a history of multiple laparotomies, including for cardioplasty.　We performed a two-stage operation to treat his severe deformity.　Postoperatively, the patient experienced prolonged appetite loss and progressive weight loss.　Gastroscopy revealed severe duodenal stenosis, and after total parenteral nutrition, gastrojejunostomy and duodenojejunostomy were performed.　A thin asthenic habitus and severe scoliosis are considered risk factors for SMA syndrome following scoliosis surgery.　It is important to note that severe SMA syndrome can occur following scoliosis surgery in a patient with a past history of laparotomy in addition to having the above risk factors.