Superior Mesenteric Artery Syndrome or Wilkie Syndrome. Clinical case

Abstract

Wilkie syndrome is a disease characterized by an extrinsic compression of the third portion of the duodenum by the superior mesenteric artery and the aorta. It is of gradual evolution producing long-term high intestinal obstructive symptoms. The diagnostic method of choice is the CT scan being the most effective and least invasive. The treatment of choice in the absence of a good response with conservative treatment, is surgical through a duodenoyeyunostomy relieving duodenal and gastric symptoms. The article presents a case of Superior Mesenteric Artery Syndrome that develops in a 45-year-old woman. The patient presents a clinical picture of colic pain in epigastrium, nausea and vomiting for several occasions, weight loss of approximately 10 Kg, upper digestive endoscopy, it is concluded as a pseudo intestinal obstruction. Abdominal tomography suggests aortomesenteric clamping of the Treitz angle (Wilkie syndrome). The patient does not improve conservative management, so duodenoyeyuno anastomosis is performed in Y of Roux and is discharged 4 days after the intervention with good oral tolerance and weight gain is evidenced by the controls. Esophagogastricoduodenal transit does not reveal areas of stenosis or dilation. It is concluded that Wilkie syndrome is an uncommon pathology of low incidence, so it is underdiagnosed, although its clinic is not easy to differentiate since it can be confused with several pathologies so that its diagnosis is made late, being the diagnostic tool more useful the TAC. Among the surgical techniques of choice, the most appropriate would be the duodenoyeyunostomy with a higher success rate and fewer complications.