Superior mesenteric artery syndrome: a rare case of upper gastrointestinal obstruction

Chrysikos, Dimosthenis; Troupis, Theodore; Tsiaoussis, John; Σγάντζος, Μάρκος; Bonatsos, Vasileios; Piperos, Τheodoros; Kalles, Vasileios; Theodoropoulos, Panagiotis; Kakaviatos, Dimosthenis; Flessas, Ioannis; Nikou, Euthumios; Mariolis‐Sapsakos, Theodoros

doi:10.1093/jscr/rjz054

Cited by 7 publications

(9 citation statements)

References 10 publications

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“…Wilkie's syndrome is considered an exceedingly rare presentation in the pediatric population [1,4]. Our case depicts a rare instance of the condition in a 12-year-old female.…”

Section: Discussionmentioning

confidence: 76%

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Wilkie's Syndrome as a Rare Cause of Duodenal Obstruction: Perspicacity Is in the Radiological Details

Faqeeh

Syed

Ammar

et al. 2020

Cureus

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Superior mesenteric artery syndrome, or Wilkie's syndrome, is an unexpected cause of upper gastrointestinal tract obstruction. The exact incidence of the condition remains unknown, and limited case reports are present in the literature. The obstruction results in the compression of the third part of the duodenum between the superior mesenteric artery and aorta. It is widely known that a lack of subcutaneous tissue in the area can precipitate the obstruction by significantly reducing the aortomesenteric angle. Wilkie's syndrome presents a clinically diagnostic challenge as patients initially remain undiagnosed with relapsing episodes of upper abdominal pain and bilious vomiting. In some cases, an acute obstruction may arise. Undertaking an initial contrast study of the upper gastrointestinal tract and a CT scan are required to confirm the diagnosis of the condition. In the present study, we elucidate the case of a 12-year-old girl who presented with upper abdominal pain and bouts of bilious vomiting. Upon extensive diagnostic evaluation, Wilkie's syndrome was diagnosed. Since the patient failed to respond to conservative treatment, a laparotomy with subsequent duodenojejunostomy was undertaken. The postoperative recovery of the patient was uneventful with no recurrence of symptoms on follow-up.

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“…Wilkie's syndrome is considered an exceedingly rare presentation in the pediatric population [1,4]. Our case depicts a rare instance of the condition in a 12-year-old female.…”

Section: Discussionmentioning

confidence: 76%

“…Superior mesenteric artery syndrome (SMAS), or Wilkie's syndrome, forms a rare but intriguing cause of upper gastrointestinal tract (GIT) obstruction. The incidence in the general population hovers between 0.013% and 0.78% [1]. In 1927, Wilkie described the detailed pathophysiology and management of SMAS [2].…”

Section: Introductionmentioning

confidence: 99%

Wilkie's Syndrome as a Rare Cause of Duodenal Obstruction: Perspicacity Is in the Radiological Details

Faqeeh

Syed

Ammar

et al. 2020

Cureus

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“…SMA syndrome is most commonly found in rapid weight loss with wasting of retroperitoneal adipose tissue that bolsters the aortomesenteric distance as seen in our patient. Rapid weight loss and wasting conditions can lead to the loss of this retroperitoneal fat tissue, resulting in the narrowing of the aortomesenteric angle [ 2 , 6 ]. This phenomenon has been observed in the setting of AIDS [ 7 ], cancer [ 8 , 9 ], eating disorders [ 4 ], cerebral palsy [ 4 ], substance abuse [ 10 ], and other catabolic and malabsorptive states [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…In fact, our patient had the ligament of Treitz divided and the third portion of his duodenum fully dissected as part of his liposarcoma resection. Duodenojejunostomy, which provides gastric and duodenal decompression, is performed most frequently in 69% of surgical cases, with a reported success rate ranging from 80% to 90% [ 3 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

Post-Operative Superior Mesenteric Artery Syndrome Following Retroperitoneal Sarcoma Resection

Wong

Sutton

Spurrier

et al. 2020

Clinics and Practice

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Superior mesenteric artery (SMA) syndrome is an uncommon phenomenon caused by the compression of the third portion of the duodenum between the aorta and the SMA. Here, we present a previously healthy 15-year-old male who presented with early satiety and 20 kg weight loss. Computed tomography (CT) demonstrated a massive retroperitoneal liposarcoma displacing the entire small intestine into the right upper quadrant. Following resection of the large mass, the patient was intolerant of oral intake despite evidence of bowel function. Abdominal CT revealed a narrowing of the duodenum at the location of the SMA. A nasojejunal feeding tube was placed past this area, and enteral nutrition was initiated before slowly resuming oral intake. Post-operative SMA syndrome is an uncommon complication but should be considered in patients intolerant of oral intake following resection of large abdominal tumors associated with extensive retroperitoneal fat loss, even in the absence of concomitant major visceral resection.

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“…A reported incidence of 0.8% was reported by Neri et al [ 9 ] in a prospective study, while other reports mention a frequency of up to 2.4%[ 10 ]. In patients with gastric bypass surgery, the reported prevalence is 0.6%[ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

Apostu¹,

Chira²,

Colcear³

et al. 2022

WJCC

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BACKGROUND Superior mesenteric artery syndrome is a disease with a complex diagnosis, and it is associated with complications that make it even harder to identify. Currently, a frequent association with psychiatric disorders has been noted. Despite numerous case reports and case series, the variability of the disease has not allowed the development of protocols regarding diagnosis and management. CASE SUMMARY A 33-year-old woman presented with abdominal pain, nausea, and bile vomiting over the last 15 mo, associated with a 15-kg weight loss over the last three months. After the onset of the symptoms, the patient was diagnosed with anxiety-depressive disorder and treated appropriately. Standard examinations excluded an organic cause, and the cause of the symptoms was considered psychogenic. The persistence of symptoms, even under treatment, prompted a computer tomography angiography examination of the abdomen and pelvis. The examination identified emergence at a sharp angle of 13.7° of the superior mesenteric artery, with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm. A diagnosis of aortomesenteric clamp was established. Surgical treatment by laparoscopic duodenojejunostomy was performed. Postoperative evolution was marked by a patent anastomosis at 1 mo, with a 10-kg weight gain and improvement of the associated anxiety. CONCLUSION This case report underlines two major aspects. One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders, with an excellent outcome when proper treatment is administered. The second aspect underlines the key role of a multidisciplinary approach and follow-up.

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Superior mesenteric artery syndrome: a rare case of upper gastrointestinal obstruction

Cited by 7 publications

References 10 publications

Wilkie's Syndrome as a Rare Cause of Duodenal Obstruction: Perspicacity Is in the Radiological Details

Wilkie's Syndrome as a Rare Cause of Duodenal Obstruction: Perspicacity Is in the Radiological Details

Post-Operative Superior Mesenteric Artery Syndrome Following Retroperitoneal Sarcoma Resection

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

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