Wilkie's syndrome

Abstract

A 60-year-old man was initially seen with intermittent epigastric pain and vomiting for 4 years preceded by a weight loss of approximately 14 kg. He had previously been treated for gastritis, but his symptoms persisted. Physical examination was unremarkable, and laboratory test results, including a complete blood picture, electrolytes, liver function test, and amylase, were normal. Upper endoscopy showed only mild chronic gastritis. Ultrasonography and computed tomography scanning of the abdomen showed dilation of the second and third parts of the duodenum (Fig 1, A) and marked engorgement of the distal segment of the left renal vein (Fig 1, B) that resulted from the compression between the superior mesenteric artery (SMA) and the aorta. This was most prominent with the patient in the supine position and decreased significantly with the patient in the left lateral position. A subsequent barium meal and follow-through demonstrated a linear compression at the third part of the duodenum causing dilation of the proximal duodenum (Fig 2). This was also compatible with compression by the SMA. A diagnosis of Wilkie's syndrome with associated left renal vein compression was made, and the patient was put on a high-calorie diet and treated conservatively with analgesia. The patient subsequently gained 3 kg in body weight, and the pain was controlled satisfactorily over the next 18 months.