Superior mesenteric artery syndrome (Wilkie Syndrome) with unusual clinical onset: Description of a rare case

Abstract

Wilkie's Syndrome is a very rare disease caused by reduction of aorto-mesenteric space with consequent duodenum compression. It can combine with left renal vein stenosis which, when symptomatic, is known as "Nutcracker Syndrome". We describe a clinical onset case with epigastric pain without vomiting in a normal weight patient. 28-year-old woman who came to our observation for intense epigastric pain after a weight loss of 14 kg in 4 months. Multidetector Computed Tomography and Ultrasound revealed gastric and duodenal overdistension with hydro-air levels, severe duodenum stenosis, and left renal vein compression. Wilkie's Syndrome is common in anorexic individuals suffering from recurrent postprandial vomiting, onset with severe epigastric pain, without vomiting, is quite unusual. High-calorie diet must be first therapeutic approach, in case of failure treatment of first choice should be endovascular stenting and, only in selected cases, surgical treatment should be used because it is very invasive and burdened with numerous complications. Failure to diagnose this disease can expose patients to serious health risks.

Lemmel’s Syndrome: Lesson Based on a Case Report

“…A similar case occurs for the diagnosis of superior mesenteric artery syndrome for which ultrasound, while not allowing the diagnosis of duodenal compression, in the presence of typical symptoms (vomiting, nausea, and weight loss) and indirect signs (reduction of aortomesenteric angle), reinforces the suspicion of LS and provides indications for further investigation with second level investigations. [ 7 ] After having ascertained the PAD, to demonstrate compression of the biliary tract, it is necessary that the diverticulum is full of intestinal contents, and this is not always possible, especially when the neck of the diverticulum is wide and promotes emptying. In our case, the suspicion of LS was induced by two factors:…”

The ultrasound findings in a rare case of Nutcracker syndrome, Wilkie's syndrome, and Dunbar syndrome combination

“…Compression can also affect only the duodenum and, if significant, can become symptomatic with nausea, vomiting, and subsequent weight loss, in this case, it is called SMA syndrome (SMAS). [ 6 ] We describe a very rare case of NCS and SMAS induced by congenital DS.…”

Double nutcracker syndrome in a patient with circumaortic venous ring: a rare case report

“…1). When the LRV has an anteroaortic course, it is known as anterior NCS (ANCS) (1) and can be acquired or, much less commonly, congenital; in the former case, it is caused by rapid weight loss and is, Renato Farina, Pietro Valerio Foti, Lorena Nicolosi, Antonio Basile in fact, very frequent in anorexic patients following a significant reduction of perivascular adipose tissue which causes aortomesenteric angle (AMA) with consequent renal vein compression and, in some cases, also duodenal compression (Superior Mesenteric Artery Syndrome) (2) which run in the aortomesenteric space.…”