Children's gypsum syndrome

　　1. Etiology

　　In the process of treating deformities with various methods, the superior mesenteric artery compresses the transverse part of the duodenum, causing mechanical obstruction and leading to this disease. Other factors such as lying on a bed with a restraint, fixation of the body with gypsum, spinal traction, and decreased abdominal wall muscle tension are also triggering factors.

　　2. Pathogenesis

　　The superior mesenteric artery originates from the abdominal aorta, passes through the inferior margin of the neck of the pancreas, crosses the transverse part of the duodenum at the level of the first lumbar vertebra into the root of the mesentery of the small intestine. It forms an acute angle with the abdominal aorta, with an average of 41°. The duodenum and the root of the transverse mesocolon, which is equivalent to the left side of the second lumbar vertebra plane, are connected to the emptying organ. The loops of the intestines here are often suspended and fixed by the musculofibrous bundle tissue from the diaphragm, the Treitz ligament, which is the most fixed part of the entire small intestine. The transverse part of the duodenum is also completely fixed to the posterior abdominal wall, with the superior mesenteric artery in front, the abdominal aorta and the spine behind. Due to these anatomical characteristics, the transverse part of the duodenum is prone to compression and obstruction.

　　Children's gypsum syndrome is mainly manifested by gastrointestinal symptoms, such as nausea, vomiting, abdominal distension, abdominal pain, and so on. The vomit is mostly brown-green, followed by coffee-colored, with abdominal distension and pain being the most prominent. Severe gastrointestinal dysfunction may lead to disorders of water and electrolyte balance, dehydration, alkalosis, hypokalemia, and other complications. Some patients may have hypokalemic arrhythmia. There is a sound of peristalsis in the abdomen. There is diffuse tenderness in the abdomen. Severe cases may develop dehydration and shock, leading to death.

　　The occurrence of plaster syndrome is caused by mechanical obstruction of the transverse part of the duodenum due to compression by the superior mesenteric artery. If it is not recognized in time or treatment is delayed, it will lead to acute gastric dilation, vomiting, hypokalemia, hypovolemia, alkalosis, and even death.

　　1. Improve the awareness and vigilance of pediatric plaster syndrome. It should be done in a timely manner to detect and treat.

　　2. Improve the design and operation technology of orthopedic treatment plans to effectively prevent the occurrence of this syndrome.

　　In the event of this syndrome, seek medical attention and treatment in a timely manner, and do not delay the treatment opportunity.

　　Once pediatric plaster syndrome patients develop typical symptoms, X-ray, electrocardiogram, abdominal ultrasound, and other examinations should be performed. Electrocardiogram may show hypokalemia, and there may be signs of gastric dilation, etc. Treatment plans are formulated based on the results.

　　1. Foods beneficial for plaster syndrome

　　Diet should be light and nutritionally balanced.

　　2. Foods to avoid for plaster syndrome

　　In terms of diet, avoid spicy, stimulating, hard, and other foods.

　　I. Treatment

　　I. Gastrointestinal Decompression

　　Once the diagnosis is clear, all the accumulated fluid in the stomach should be aspirated by gastrointestinal decompression, and fasting should be maintained until the aspirated fluid is normal, then start with small amounts of liquid food and gradually increase.

　　II. Relieve the Compression of the Duodenum

　　Remove the cast and frequently change the position to relieve the compression of the duodenum.

　　III. Symptomatic Treatment

　　Correct electrolyte and acid-base imbalances in a timely manner.

　　IV. Laparotomy

　　If the above measures are ineffective, laparotomy can be performed.

　　V. Change the Orthopedic Treatment Plan

　　In some cases, it may be necessary to remove the internal fixation of the corrected deformity, or reduce the correction angle or correct the deformity in stages to prevent the recurrence of this syndrome.

　　II. Prognosis

　　If this symptom is not detected and treated appropriately in time, it may lead to death.