WILKIE’S SYNDROME AS A RARE CAUSE OF UPPER GASTROINTESTINAL OBSTRUCTION IN A THIN YOUNG LADY

Abstract

Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal (UGI) obstruction. Also known as Wilkie’s syndrome, it is caused by compression of third part of duodenum due to narrowing of the angle between SMA and abdominal aorta which results in symptoms of duodenal outflow obstruction. The cause must be sought and treat. Our patient is a thin 21-year-old lady with no known medical illness, who presented with 3 months history of post prandial bilious vomiting associated with dysphagia, loss of weight and loss of appetite. Abdominal examination revealed distended abdomen with positive succusion splash. Blood investigations showed that she was anaemic, had hyponatraemia and hypokalaemia. Abdominal x-ray revealed dilated stomach. Oesophagogastroduodenoscopy (OGDS) revealed dilated stomach filled with food particles. Computed Tomography (CT) abdomen done revealed partial obstruction at third part of duodenum with narrowed angle between abdominal aorta and SMA. Diagnosis of SMA syndrome was made. Laparoscopic converted to open gastrojejunostomy was done. Post operatively, patient developed gastroparesis and was treated with prokinetics. She was discharged well after 10 days of operation. SMA syndrome is diagnostically challenging as there are many disorders which mimic its clinical presentation. Although rare, it should be kept in mind as a cause of UGI obstruction as it is potentially curable.