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

Abstract

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.

Robotic assisted kidney auto‐transplantation as a safe alternative for treatment of nutcracker syndrome and loin pain haematuria syndrome: A case series report

“…These patients showed improvements in pain and depression at 1 year post surgery (Campsen 2020). Chronic pain and delayed diagnoses have an impact on mental health and quality of life, especially in cases like SMAS and MALS, where the cause may be an anxiety‐depressive disorder, thereby making pain and depression a vicious cycle of disease progression 17 …”

Superior Mesenteric Artery Syndrome in an Adolescent Female with Anorexia Nervosa

“…Other symptoms may include early satiety and abdominal distension. 4 These nonspecific symptoms often delay the diagnosis.…”

“…However, SMAS developed from other etiologies can also simulate anorexia nervosa, and patients may develop food aversion as a palliative measure for obstructive symptoms. 4 Concern for SMAS should be investigated with radiographic studies. Upper gastrointestinal series demonstrates obstruction of the distal duodenum, and abdominal CT with angiography reveals a narrowed aortomesenteric angle, a compressed distal Abdominal and pelvic computed tomography (CT) revealed a markedly distended stomach and distended duodenal sweep into the middle abdomen ( Figures A, B).…”

“…7 If conservative measures fail, surgical intervention with duodenojejunostomy may be considered. 4 Strong's procedure and gastrojejunostomy have fallen out of favor due to high failure rate. 4 In conclusion, we report a severe case of SMAS in an adolescent female with anorexia nervosa who presented with acute on chronic symptoms of bowel obstruction.…”

Nursing of a lactating patient with superior mesenteric artery syndrome: a case report

“…Antidepressant medication and psychological counselling may improve a patient’s mood, and an increase of adipose tissue may improve the angle between the aorta and SMA, alleviating the clinical compression symptoms of SMAS. 13 Regarding enteral nutrition, continuous and effective drainage is important for observation and protection against infection. If the line care is inadequate, related complications will occur.…”