EUS assessment of GI subepithelial tumors

Abstract

CO RR EC TE D PR OO F Introduction: Superior mesenteric artery (SMA) syndrome or Wilkie's syndrome, is a rare acquired vascular compression disorder in which acute angulation of superior mesenteric artery (SMA) results in compression of the third part of the duodenum leading to obstruction. Case report: Female, 25 years old, was hospitalized with abdominal pain, early satiety, epigastric fullness, nausea, vomiting of partially digested food, and 8 kg weight loss over 2 months. She had a history of chronic gastritis and lactose intolerance. Previously clinical investigation excluded Gastroenterology or Neuro-psychiatric disorders andwas sent to Internal Medicine Ward. Physical examination revealed a cachectic patient. (W: 45 kg, H: 1,55 m: BMI: 18.75) Abdominal examination revealed non distended abdomen, mild epigastric tenderness, and hyperactive bowel sounds. There was no palpable organomegaly or clinical signs of ascites. She was treated with fasting, parenteral glucose solution, IBP and domperidona andmetoclopramide. An extrapyramidal complication of the use of neuroleptic was described on the second day. Analytical showed normochromic anemia and mid hipoproteinemia. Abdominal radiograph revealed a dilated stomach. Subsequent abdominal computerized tomography (CT) scan showed a compression of third part of duodenum. An angio IRM confirmed a diminution of aortomesenteric angle (b24 cm) suggesting Wilkie's syndrome. The patient was treated with enteric diet through nasoyeyunal tube followed by frequent small meals and posturing maneuvers, with a progressive improvement. The patient was discharged asymptomatic. Conclusion: The defining feature of this entity is upper gastrointestinal obstruction caused by compression of the third part of the duodenum between the SMA anteriorly and the aorta posteriorly. Chronic cases may present with long-standing vague abdominal symptoms, early satiety and anorexia, or recurrent episodes of abdominal pain, associated with vomiting and interpreted for psychiatric disorders like in our patient. The diagnosis is based on clinical symptoms and radiologic evidence of obstruction and treatment has consisted of conservative measures like in our patient. In several cases a Laparoscopic surgery might be the solution.