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Vascular compression of the duodenum associated with the treatment of scoliosis. Review of the literature and report of eighteen cases.

Thirty cases of vascular duodenal obstruction have been collected from the literature and from our own experience: eighteen associated with the correction of spinal curvature and twelve with the application of a body jacket. The clinical manifestations and treatment of vascular duodenal obstruction have been presented and the pathogenesis of this entity has been discussed. It is believed that traction on the spine in patients with scoliosis with significant correction of the spinal curvature (21 to 61 degrees in our series) may increase the acuteness of the angle of departure of the superior mesenteric arterial trunk sufficiently to cause duodenal obstruction. Correction of a curvature of the spine, especially abrupt correction produced by internal spinal fixation, halo-femoral traction, a localizer cast, or Milwaukee brace, may apply the requisite traction.

The term cast syndrome is a misnomer when used to describe the vascular duodenal obstruction that may develop as a complication of the treatment of scoliosis without the application of a corrective cast.