Skip to main content
AAPM&R 2025 Main banner
JFK
Final Program


Official Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
On Demand
On Demand
In-Person
In-Person
Livestream
Livestream
Invite Only
Invite Only
Ticketed
Ticketed
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
Rate ePoster

Pediatric Rehabilitation

Unmasking Superior Mesenteric Artery Syndrome in a Pediatric TBI Survivor: A Case Report.

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Case Report Theater

    Poster Presenter(s)

  • Emory L. Reyes, DO

    Resident Physician
    University of Arkansas for Medical Sciences PM&R Program
    Pomona, California

    • Co-Author(s)

  • AL

    Aimee M. Lambeth, DO

    Assistant Professor of Pediatric Rehabilitation Medicine
    Children's Mercy Kansas City
    Little Rock, Arkansas

Disclosure(s):
Emory L. Reyes, DO: No financial relationships to disclose
Case Diagnosis: 12-year-old boy with severe traumatic brain injury (TBI) resulting in left spastic hemiparesis and dysphagia

Case Description or Program Description: Patient was admitted to inpatient rehabilitation three weeks following a gunshot wound to the head status post right frontal craniotomy. Initial head CT noted significant intracranial ballistic injury, multifocal hemorrhages and left midline shift. Patient was severely underweight on admission at 33.2kg ( < 3rd percentile), Rancho Los Amigos V with left hemiparesis, alogia, and dysphagia requiring G-tube. Initially, he presented with persistent nausea, postprandial abdominal pain and non-bilious emesis leading to a weight drop to 27.6kg by 11 weeks. Symptoms were refractory to medication and feed adjustments, but did not impair rehabilitation progress. Oral intake increased as dysphagia improved but weight loss persisted.

Setting: Inpatient rehabilitation unit within a pediatric hospital

Assessment/Results: Possible contributing factors included limited capacity to report symptoms, anxiety, GERD, tube feed satiety, fear of nausea, and restrictive food intake due to prior food insecurity. With ongoing weight loss, further gastrointestinal workup was pursued. Gastric emptying study did not reveal motility abnormalities; however, CT Abdomen/Pelvis revealed superior mesenteric artery (SMA) syndrome with an SMA angle of 8°. Patient transitioned to GJ tube in order to bypass the duodenum. Following conversion and advancement of tube feeds, weight improved to 34.1kg over 5 weeks with better feed tolerance.

Discussion (relevance): SMA syndrome is rare and involves duodenal obstruction by the SMA in patients with weight loss and loss of abdominal fat. Diagnosing SMA in pediatric TBI patients is challenging due to communication barriers compounded by the complex neurological and gastrointestinal symptoms which may accompany TBI. SMA syndrome should be considered in TBI patients with persistent vomiting and weight loss, particularly in underweight children or those with additional risk factors such as food insecurity.

Conclusions: Although rare, SMA syndrome should be considered in pediatric TBI survivors with refractory weight loss.