Posttraumatic superior mesenteric artery syndrome following a chance fracture in a child: a case report

Superior mesenteric artery syndrome (SMAS) is a rare but important cause of acute upper gastrointestinal obstruction resulting from compression of the duodenal third portion between the superior mesenteric artery and aorta. While SMAS has been described after corrective spinal surgery, it is rarely reported following pediatric trauma. We describe an 8-year-old boy involved in a high-speed motor vehicle collision who sustained multiple severe injuries, such as traumatic diaphragmatic hernia, mesenteric vascular injury, hepatosplenic laceration, and L1–L2 seatbelt-related Chance fracture-dislocation. After surgical stabilization of the spine on day 6, he presented on day 12 with bilious vomiting and abdominal distension, indicating the presence of intestinal obstruction. Contrast-enhanced computed tomography and an upper gastrointestinal series demonstrated narrowing of aorto-mesenteric angle with compression of the duodenal third portion, confirming the diagnosis of SMAS. Through nasojejunal tubal feeding, he was able to meet nutritional requirements without parenteral nutrition. This case underscores the need for heightened awareness of SMAS in pediatric trauma patients who develop postoperative duodenal obstruction symptoms, as prompt recognition and conservative management in the postoperative setting can lead to excellent outcomes.