In 1878, Willatt first reported a case of acute gastric dilatation symptoms caused by the use of hip spica plaster, naming it Cast Syndrome. In 1971, Evarts reported that patients not treated with plaster for scoliosis or kyphosis could also experience nausea and repeated vomiting symptoms. He believed that Cast Syndrome was a misnomer. Since such treatment methods have been widely applied, this condition is not uncommon.

bubble_chart Pathogenesis

Long-term supine positioning, such as with gypsum fixation, pelvic traction, spinal internal distraction fixation (Harrington rod), skull-pelvic traction (halo-pelvic traction), or spinal stretching, can all aggravate compression on the duodenum by the superior mesenteric artery. This may subsequently lead to obstruction of the superior mesenteric vein, resulting in symptoms of acute gastric dilation.

bubble_chart Clinical Manifestations

The severity of symptoms depends on the degree of compression of the transverse duodenum by the stirred pulse on the mesentery. In the early stages, only upper abdominal fullness and distension are felt, and nausea may occur, especially in postoperative patients. These mild symptoms are easily overlooked. Subsequently, vomiting appears and gradually becomes more frequent, with vomitus often being brownish-green and later turning coffee-colored. Abdominal splashing sounds can be heard. There is diffuse tenderness throughout the abdomen. In severe cases, dehydration may occur, leading to shock and death.

bubble_chart Auxiliary Examination

1. Vomiting with strongly positive occult blood.

2. Hypokalemic, hypochloremic alkalosis.

3. Electrocardiogram shows hypokalemic changes.

bubble_chart Diagnosis

A clear history of spinal traction surgery and typical symptoms of mesenteric artery pulsation syndrome. A plain abdominal X-ray can confirm the diagnosis.

bubble_chart Treatment Measures

1. Gastrointestinal decompression, gastric lavage with warm saline.

2. Remove the disease cause, change to supine position, and if the condition permits, switch to prone position with foot elevation.

3. Replenish blood volume, correct typical edema, electrolyte, and acid-base imbalances.

4. If the condition does not improve, active surgical treatment should be performed, such as Treitz ligament release.

5. If necessary, remove the gypsum or temporarily discontinue traction, or reduce the correction angle.

bubble_chart Differentiation

It should be differentiated from acute gastritis, pyloric obstruction, cholera, and cerebral vomiting.