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Cast syndrome, clinically known as superior mesenteric artery syndrome (SMAS), is gastric dilatation with partial or complete obstruction of the duodenum. Although rare, it is most frequently seen in orthopaedic patients who have had spinal surgery or who are in hip spica or body casts. Obstruction occurs when there is compression of the duodenum between the superior mesenteric artery anteriorly and the aorta and spinal column posteriorly. Obstruction can occur within days of surgery or casting or may not develop for several weeks. Treatment for SMAS varies from conservative nonoperative to operative procedures. Complications can be severe if symptoms are not quickly recognized and treatment instituted in a timely manner.
Superior mesenteric artery syndrome (SMAS), better known as cast syndrome in orthopaedic patients, is gastric dilatation with partial or complete obstruction of the duodenum. Cast syndrome is a rare but serious complication most frequently seen in orthopaedic patients who have been placed in a hip spica or body cast. The term is frequently used by orthopaedic nurses but may be applied in inappropriate situations based on a lack of knowledge of cast syndrome etiology
Cast syndrome is a misnomer as superior mesenteric artery syndrome is seen in orthopaedic patients who do not have body casts, primarily patients who have undergone spinal fusion and distraction. Other terms used in medicine to refer clinical findings similar to those found in SMAS include gastric outlet syndrome, small bowel obstruction, acute gastric dilatation, chronic duodenal ileus, Wilks syndrome, and gastrectasis (Chen et al., 1992; Dorph, 1950; Hutchinson & Bassett, 1990).
Review of Literature
Even though cast syndrome is well known to orthopaedic surgeons, there is scant research on this subject. Most of the literature is a discussion of case studies encountered by orthopaedic surgeons over the past 50 years.
The term cast syndrome is somewhat misleading but is most frequently credited to Dorph (Epps, 1994; Magalini et al., 1990; Reid & Gamon, 1971; Warner et al., 1974). The basis of the term comes from cases reported over the years where there were associations between arteriomesenteric duodenal obstruction and immobilization of patients in body casts. Dorph (1950) reviewed cases dating back to lhe 1800s which theorized duodenal obstruction resulting from cast pressure causing compression of the duodenum between the...