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

Abstract

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.