Abstract
Wilkie’s syndrome, or superior mesenteric artery syndrome, is a rare condition of duodenal obstruction caused by compression of the superior mesenteric artery on the third part of the duodenum. The diagnosis should be considered in a patient who has experienced significant weight loss and now presents with persistent vomiting, especially if the vomiting occurs with the patient in the supine position and is alleviated by the lateral or prone position. The diagnosis can be confirmed by imaging studies demonstrating compression of the third part of the duodenum, and the main aim of treatment should be to pass a feeding tube beyond the point of obstruction to allow enteral feeding. The condition improves spontaneously with weight gain. Further treatment options include parenteral feeding and operative bypass in select cases. Here we present a case of Wilkie’s syndrome in a trauma patient with significant weight loss, together with a review of the literature on this interesting topic.
Highlights
Superior mesenteric artery syndrome or what is called Wilkie’s syndrome is one of the rare causes of duodenal obstruction
The superior mesenteric artery usually forms an angle of approximately 45 degrees with the abdominal aorta, and the third part of the duodenum crosses caudal to the origin of the superior mesenteric artery, coursing between the superior mesenteric artery and aorta
Any factor that sharply narrows the aortomesenteric angle can cause entrapment and compression of the third part of the duodenum as it passes between the superior mesenteric artery and aorta, resulting in Superior mesenteric artery syndrome (SMAS) [6, 7]
Summary
Superior mesenteric artery syndrome or what is called Wilkie’s syndrome is one of the rare causes of duodenal obstruction. Abdominal X-ray showed no signs of obstruction or ileus (normal small bowel gas pattern) He was given a gastrografin meal which was delayed in the stomach and only progressed into the second part of the duodenum after more than 12 hours. Seeing as he had lost a large amount of weight during the above course of events and was fairly emaciated, coupled with the fact that he was nursed predominantly on his back for his lumbar spine fracture and paraplegia, we suspected he may have Wilkie’s syndrome. Figure 2: 3D reconstruction of the image seen in (Figure 1)
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