Superior mesenteric artery (Wilkie’s) syndrome: a rare cause of upper gastrointestinal system obstruction

Abstract

Background Superior mesenteric artery syndrome (SMAS) results from the compression of the third part of the duodenum between the aorta and the proximal part of the superior mesenteric artery (SMA). Clinical presentation of SMAS is characterized by the dilatation of the proximal part of the third part of the duodenum. SMAS is a rare cause of the upper gastrointestinal system (UGS) obstruction. In this study, we aimed to present our clinical experience in the treatment of five patients with SMAS, which is a rare clinical condition requiring surgery.

Patients and methods The retrospective study included five patients who were treated due to SMAS at our clinic between January 2010 and January 2014.

Results All the patients were underweight, with a mean BMI of 15.73 (14–16). The clinical symptoms included epigastric pain after food intake, large volume bilious emesis, early satiety, failure to gain weight, indigestion, esophageal reflux, sense of fullness, and persistent weight loss. SMAS was diagnosed using barium meal studies, upper gastrointestinal endoscopy, abdominal ultrasonography, and CT angiography. Four patients underwent duodenojejunostomy and one patient was managed with gastrojejunostomy. No complication was observed during the postoperative period, and all the patients achieved significant improvement in symptoms.

Conclusion SMAS is a rare cause of UGS obstruction, and the diagnosis of SMAS is often delayed. SMAS should be suspected in the differential diagnosis of the patients with unsubstantiated symptoms of persistent nausea, emesis, and significant weight loss.

Keywords:

• Duodenojejunostomy
• emesis
• nausea
• superior mesenteric artery syndrome
• weight loss

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.