Method This is a case of a previously well 17 year old girl with cerebral palsy secondary to Lissencephaly. She presented with a history of intractable vomiting progressing over the course of a few months secondary to severe worsening scoliosis.
Upon further investigation, it was felt that the extensive degree of her scoliosis was rotating her abdominal anatomy in such a manner to be the main cause of her vomiting. She was reviewed by the orthopaedic team who felt that correction of her scoliosis was indicated however this was not without significant risks to the patient especially given her extensive recent weight loss secondary to the vomiting. However, without the procedure the patient would continue to vomit and losing weight and may eventually die.
Result The parents of the patient were keen to proceed with the operation despite the high risks as they felt their daughter’s quality of life had deteriorated significantly since the onset of the scoliosis and recurrent vomiting.
The patient underwent the scoliosis correction and made a good recovery.
Conclusion This case presents a dilemma in which without correction of her scoliosis, the patient would continue to vomit and lose weight (medical therapy had failed). However, undertaking such a major operation in this patient carried a significant mortality risk.
The case also highlights the importance of close follow up of these patients as this child did not develop scoliosis until her teenage years and she missed her follow up appointments due to an address change.
Pictures of the scoliosis (X ray/CT are available to accompany the case)
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