Acute maagdilatatie en A. mesenterica superior-syndroom bij zwakzinnigen

Three mentally retarded male patients, 24, 30 and 14 years old, died from acute gastric dilatation leading to rupture and perforation. Superior mesenteric artery syndrome (SMA) was the cause of gastric dilatation in two of them. In the third patient the cause was not clear. The three patients had scoliosis and were underweight or thin. Two had spastic quadriplegia of perinatal origin and one had Down's syndrome. One patient with SMA was treated by Nissen fundoplication because of hiatus hernia with vomiting and gastro-oesophageal reflux one week before he died. Another patient had a severe gastric bleeding after decompression of the dilatation. In mentally retarded patients there are often several predisposing factors for SMA (anorexia, severe weight loss in a short time, pronounced lumbar lordosis, scoliosis, correction of scoliosis by operation or plaster cast, prolonged lying position, boulimia). Gastric dilatation may be prevented by ensuring adequate nutritional status.