Pranav Bollavaram, MD
Resident Physician
The Ohio State University
Columbus, Ohio, United States
Acute superior mesenteric artery syndrome following traumatic spinal cord injury.
Case Description:
This case describes a 20-year-old woman with a history notable for anxiety. She sustained a motor vehicle accident and resulting T10-level complete spinal cord injury (SCI). Following surgery, she was admitted to an inpatient rehabilitation (IPR) hospital. While undergoing rehabilitation, she demonstrated intractable nausea and vomiting. This was refractory to oral, intramuscular, and intravenous antiemetics. She did not tolerate enteral access. CT angiogram of the abdomen was suggestive of superior mesenteric artery (SMA) syndrome. Collateral history revealed a 20-pound weight loss since the time of her injury. Gastroenterology was consulted and she was re-admitted to the acute care hospital for parenteral nutrition. Following improvement in nutrition and oral intake, she returned to IPR and made accelerated functional gains.
Discussions:
This case highlights one of the rare sequelae of spinal cord injury. While nausea and poor intake may be related to neurogenic bowel, gastroparesis, or abdominal pain, there have been few documented cases of SMA syndrome following SCI. In the setting of rapid weight loss with an already small body habitus, this patient was prone this complication; recognition of this risk allowed for identification and initiation of enteral and parenteral nutrition. This case is unique in that prior documentations of SMA syndrome following SCI follow a timeline of months prior development of symptoms. In this instance, symptoms emerged within 3-weeks of injury, which may be related to the patient’s aforementioned risk factors.
Conclusions:
Oral intolerance is common following acute spinal cord injury; however, the differential diagnosis remains broad. Based on the patient’s presentation and risk factors, it is important to consider SMA syndrome as a possibility both in the immediate and chronic post-traumatic periods. Consideration of this diagnostic possibility can expedite identification and management and minimize patient discomfort.
