BODYCAST - THE OFFICIAL JOURNAL OF THE CSOT Beware the cast syndrome Reprinted with permission of the author. Cast syndrome is a condition called such because of its association in history with the application of body casts in the management of congenital and acquired spinal deformity trauma and spondylolisthesis. There are many names associated with the same clinical syndrome of posture-related profuse vomiting. Wilkie's syndrome, superior mesenteric artery syndrome (SMAS), aortomesenteric duodenal compression or chronic duodenal ileus, and the reporting of such conditions in surgical literature dates back to 1750. The cause of these symptoms is related to the anatomy of the duodenum on the back wall of the abdomen and is a complication of standing upright having been designed to walk on all fours. The third part of the duodenum passes between the aorta and its superior mesenteric artery - (SMA) branch. The superior mesenteric artery arises from the anterior aspect of the aorta at the level of the Ll vertebral body. It is encased in fat and lymphatic tissue at its origin and descends downwards at an acute angle into the mesentery. The duodenum usually passes across the aorta at the level of the L3 vertebral body and is suspended in the acute angle between aorta and SMA by the ligament of Treitz. Any factors disturbing the close relationship of this anatomy may lead to extrinsic compression of duodenum. A congenitally short suspensory ligament of Treitz will pull the duodenum higher. pinching it in the axilla of the acute angle of SMA and aorta. Acquired causes include weight loss in patients suffering debilitating illness such as malignancy. malabsorption, extensive burns or anorexia nervosa when fat is depleted at the origin of the SMA surrounding the duodenum.
This abstract is a portion of the article
which appears in the Winter 2007 issue of BodyCast.
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