When dilation and obstruction of the duodenum occur after the application of a Risser body cast or body jacket and produce pernicious vomiting, aspiration, and sometimes death, the condition is termed "cast syndrome." A patient with such a syndrome is presented and 37 cases reported in the literature are reviewed. Our patient had congenital scoliosis treated with a spinal fusion and Harrington rod instrumentation. Following the operation, she was placed in a total body cast. She developed pernicious vomiting and became moribund. Treatment consisted of removal of the cast and medical treatment with intermittent nasogastric tube decompression, neostigmine (Prostigmin) methylsulfate, position alteration, and intravenous hyperalimentation. After no response, duodenojejunostomy was successfully performed.