Delayed Diagnosis of SMA Syndrome? What Should You Do?

Your teenager has scoliosis. You get the surgery to correct the problem, but a week later they are throwing up constantly, complaining of abdominal pain. Or they have been losing weight lately and now they are vomiting. Could it be an eating disorder? Or you are training hard for that marathon? Now you’re slender and fit but can’t seem to keep anything down.

Superior mesenteric artery syndrome is a rare digestive condition that can affect people of all ages. Although it can be caused by a variety of factors, it sometimes shows up after spinal surgery, in patients with eating disorders, or in athletes who train excessively. Worse, SMA syndrome can be debilitating and even life-threatening.

What Is Superior Mesenteric Artery Syndrome?

SMA syndrome is caused when the first part of the small intestine is compressed between the aorta and the superior mesenteric artery. The pressure causes partial or complete blockage and debilitating syndromes, which can include:

• Abdominal pain in the mid-abdomen, which is resolved by lying on the left side or drawing one’s knees to one’s chest.
• A feeling of fullness or bloat after meals.
• Nausea
• Weight loss

SMA syndrome can result in life-threatening complications including aspiration pneumonia, gastric perforation (holes in the stomach), and electrolyte abnormalities. The increased blood speed through the artery can also cause cardiac arrest.

The primary cause of SMA syndrome is sudden and dramatic weight loss, which can cause the loss of the mesenteric fat pad. This is a sheath of fat that surrounds the superior mesenteric artery and keeps it in place. Without that pad, the angle between the two arteries can tighten, trapping part of the duodenum. Thus, this is caused by:

• Eating disorders, especially anorexia nervosa.
• Celiac disease, which can cause extreme weight loss.
• Orthopedic casting and incapacitation.
• Surgery, especially spinal surgery. One of the most common causative factors in younger people is surgery to correct scoliosis.
• Excessive exercise, such as athletic overtraining. SMA syndrome is sometimes seen in soldiers going through intense training.
• Gastric bypass surgery

Because a common cause is a spinal surgery to correct scoliosis, SMA syndrome is common in children and adolescents, and as a parent, you may have experienced extreme distress at what has happened to your child.

How Can Spinal Surgery Cause SMA Syndrome?

Surgery to correct the spine can affect the position of the arteries. This is particularly true of scoliosis surgery resulting in lengthening of the spine. Adolescents that are already going through a growth spurt are at particular risk. The changes in the angle of the spine can pull the arteries together.

The complication is rare, and normally shows up between one to two weeks after the surgery, but can turn up years later. A competent surgeon is less likely to cause problems, but the biggest issue is delayed or incorrect diagnosis.

Why Do Doctors Often Incorrectly Diagnose SMA Syndrome?

The biggest problem, as mentioned, is an incorrect diagnosis. Indeed, SMA syndrome can be misdiagnosed as stomach flu, an eating disorder, ulcers, irritable bowel syndrome, or gastroparesis, which is sluggish emptying of solid food common in diabetics. In fact, a lot of other diseases present very similarly. Doctors should suspect SMA syndrome if the patient has recently had spinal surgery and/or has lost a lot of weight in a short period of time. Far too many doctors will also assume that in patients with an eating disorder all of their symptoms are caused by the disorder. Thus, they may be extremely dismissive when an adolescent presents with these symptoms. There have been instances where SMA syndrome is classified as “anxiety”.

Early SMA treatment is important. In fact, delayed or incorrect diagnosis can result in significant problems for the person and their family, including the need to opt for surgery and long term symptoms, and even death.

SMA is treated conservatively with early diagnosis. Treatments include:

• A special diet of high-calorie food to restore weight.
• IV nutrition.
• A nasogastric tube to deliver fluids and electrolytes.
• Nasogastric decompression (reducing the contents of the stomach by removing them through the nose).
• Positional feeding is where the patient, after eating, is put into a position to relieve pressure. This can allow them to get enough nutrition to restore the fat in the abdomen and push the arteries back into place.

In fact, positional feeding and a special diet alone can be enough for some patients to recover. Others may need more intensive treatment and, as mentioned, some may never fully recover and have to live with SMA syndrome their entire lives.

What Should I Do Next?

If you or your child have had corrective SMA syndrome surgery, then determine if it was your doctor’s fault. SMS is rare and diagnosis is difficult. However, if your doctor was dismissive of the problem, then you may well have a case.

You should have your or your child’s situation assessed by an independent doctor. Then, contact an experienced medical malpractice lawyer. A second doctor will be able to help determine whether delayed diagnosis caused the problem. In some cases, even surgery will not correct the problem and symptoms will continue to recur, resulting in a shortened lifespan and prolonged debilitation. And yes, SMS syndrome is life-threatening.

Learn More About a Delayed Diagnosis of SMA Syndrome

A lawyer will generally offer a free initial consultation, in which they will determine whether your case has merits. A good lawyer will not take on a case that they cannot win. There is nothing wrong with pursuing a malpractice suit if you have reason to believe that a doctor messed up by delaying a diagnosis, and that the delay caused ongoing health problems or the need for expensive surgery.

If you or your child has SMA syndrome that was not diagnosed in a timely matter, you should contact Weltchek Mallahan & Weltchek for a consultation.