|IMAGE OF INTEREST
|Year : 2022 | Volume
| Issue : 3 | Page : 110-111
Arulprakash Sarangapani, Tarun J George
Department of GI Sciences, Advanced Endoscopy and Liver Diseases, MGM Health Care, Chennai, Tamil Nadu, India
|Date of Submission||20-Mar-2022|
|Date of Decision||10-May-2022|
|Date of Acceptance||15-May-2022|
|Date of Web Publication||05-Jul-2022|
MGM Health Care, Nelson Manickam Road, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sarangapani A, George TJ. Wilkie's syndrome. Gastroenterol Hepatol Endosc Pract 2022;2:110-1
A 12-year-old girl presented with a repeated history of persistent vomiting and upper abdomen pain for the past 6 months. She used to have severe abdomen discomfort after taking food and vomiting of food particles. She had significant weight loss. Being evaluated elsewhere and treated symptomatically, visited our clinic for evaluation. She underwent upper glycemic index endoscopy which showed a dilated duodenum. Computed tomography (CT) abdomen revealed distension of the proximal duodenum and compression of the third portion of the duodenum [Figure 1] between the aorta and the superior mesentery artery, with a measured aortomesenteric distance of 5 mm and an angle of 16.4°. These findings were consistent with superior mesenteric artery syndrome (Superior mesenteric artery [SMA] syndrome), also known as Wilkie's syndrome. She underwent laparoscopic duodenojejunostomy and was doing well on follow-up.
|Figure 1: Contrast CT abdomen showing dilated duodenum with narrowing at the level of third part of duodenum. Aortomesenteric angle of the aortomesenteric distance of 5 mm and an angle of 16.4°. These findings were consistent with superior mesenteric artery syndrome (Wilkie's syndrome). CT: Computed tomography|
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SMA syndrome is a rare cause of upper gastrointestinal obstruction. First, it was described by D. Wilke as chronic duodenal ileus in 1912, also termed arteriomesenteric duodenal compression syndrome, the cast syndrome in history. It is caused by compression of the third part of the duodenum by the superior mesenteric artery or one of its branches anteriorly and aorta posteriorly leading to upper gastrointestinal obstruction of varying severity. This obstruction may be partial or complete, acute or chronic, and severity depends on the degree of obstruction. Short intestinal mesentery, anomalous SMA, high fixation of the duodenum, and weight loss (acute or chronic) are among the most common causes of this syndrome. Anatomically, the SMA leaves the aorta at an acute angle that is sustained by adipose tissue, this tissue functions as a natural fatty cushion and prevents extrinsic compression. The estimated prevalence in the general population varies between 0.013% and 0.78%. It usually affects young adults and symptoms include abdomen pain, chronic vomiting, and weight loss. Diagnosis is with typical clinical features and contrast CT abdomen. The normal SMA-aorta angle of origin ranges between 20° and 70° whereas in Wilkie's syndrome it is very steep ranging from 6° to 15° consequently, a decrease in the aortomesenteric distance to <10 mm (usually ranging from 10 to 28 mm).
Conservative therapy mainly consists of weight gain achieved orally or parenterally, with the aim of restituting the mesenteric fat pad and increasing the aortomesenteric angle. Duodenojejunostomy, the preferred surgical approach is reserved for patients with severe symptoms and failure of conservative treatment.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Wilkie, DP. Chronic duodenal ileus. Br J Surg 1921;9:204.
Mathenge N, Osiro S, Rodriguez II, Salib C, Tubbs RS, Loukas M. Superior mesenteric artery syndrome and its associated gastrointestinal implications. Clin Anat 2014;27:1244-52.
Merrett ND, Wilson RB, Cosman P, Biankin AV. Superior mesenteric artery syndrome: Diagnosis and treatment strategies. J Gastrointest Surg 2009;13:287-92.