S3700 A Rare Case of Superior Mesenteric Artery (SMA) Syndrome, or Wilkie's Syndrome (WS) in a Patient With Cannabinoid Hyperemesis Syndrome (CHS)

Superior mesenteric artery syndrome (SMA syndrome) or Wilkie’s syndrome is a rare etiology of duodenal obstruction due to compression of the third portion of the duodenum between the superior mesenteric artery and the aorta. Physical and laboratory findings are often non-specific but imaging methods are useful for diagnosing the condition. A 46-year-old female patient presented to the outpatient clinic of our internal medicine department with a 2-year history of epigastric pain, nausea, early satiety and weight loss of 15 kg. Previous studies were inconclusive. The patient underwent computed tomography enterography and its findings were consistent with SMA syndrome. Currently the patient is being followed by General Surgery and Nutrition and is under nutritional measures in order to optimize her body mass index to decrease possible surgical complications.This case report emphasizes the importance of clinical suspicion and careful investigation when considering less common etiologies for frequent gastrointestinal symptoms.

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Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0063 ◽

2017 ◽

Vol 99 (6) ◽

pp. 472-475 ◽

Cited By ~ 6

Author(s):

GC Kirby ◽

ER Faulconer ◽

SJ Robinson ◽

A Perry ◽

R Downing

Keyword(s):

Weight Loss ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Epigastric Pain ◽

Superior Mesenteric Artery Syndrome ◽

Team Approach ◽

The Third ◽

Wilkie’S Syndrome ◽

Sma Syndrome ◽

Open Gastrojejunostomy

INTRODUCTION The superior mesenteric artery (SMA) syndrome, or Wilkie’s syndrome, is a rare cause of postprandial epigastric pain, vomiting and weight loss caused by compression of the third part of the duodenum as it passes beneath the proximal superior mesenteric artery. The syndrome may be precipitated by sudden weight loss secondary to other pathologies, such as trauma, malignancy or eating disorders. Diagnosis is confirmed by angiography, which reveals a reduced aorto-SMA angle and distance, and contrast studies showing duodenal obstruction. Conservative management aims to increase intra-abdominal fat by dietary manipulation and thereby increase the angle between the SMA and aorta. Where surgery is indicated, division of the ligament of Treitz, anterior transposition of the third part of the duodenum and duodenojejunostomy have been described. METHODS We present four cases of SMA syndrome where the intention of treatment was laparoscopic duodenojejunostomy. The procedure was completed successfully in three patients, who recovered quickly with no short-term complications. A fourth patient underwent open gastrojejunostomy (complicated by an anastomotic bleed) when dense adhesions prevented duodenojejunostomy. CONCLUSIONS The superior mesenteric artery syndrome should be considered in patients with epigastric pain, prolonged vomiting and weight loss. Laparoscopic duodenojejunostomy is a safe and effective operation for management of the syndrome. A multi-speciality team approach including gastrointestinal, vascular and radiological specialists should be invoked in the management of these patients.

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Wilkie's Syndrome or Superior Mesenteric Artery Syndrome: Fact or Fantasy

Case Reports in Gastroenterology ◽

10.1159/000431307 ◽

2015 ◽

Vol 9 (2) ◽

pp. 194-199 ◽

Cited By ~ 22

Author(s):

Vera Zaraket ◽

Liliane Deeb

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Early Recognition ◽

Fatty Tissue ◽

Non Invasive ◽

Wilkie’S Syndrome ◽

Gastrointestinal Obstruction ◽

Sma Syndrome ◽

Upper Gastrointestinal ◽

High Intestinal Obstruction

Superior mesenteric artery (SMA) syndrome (known as Wilkie's syndrome) is a rare cause of upper gastrointestinal obstruction. It is an acquired disorder in which acute angulation of the SMA causes compression of the third part of the duodenum between the SMA and the aorta. This is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a 17-year-old female who presented with intermittent abdominal pain and intractable vomiting following significant weight loss after hospitalization for pneumonia. Symptoms persisted for 2 years and the patient underwent extensive invasive and non-invasive tests, but to no avail. Thereafter she developed acute high intestinal obstruction, which unraveled her diagnosis. This case emphasizes the challenges in the diagnosis of SMA syndrome and the need for increased awareness of this entity. This will improve early recognition in order to reduce irrelevant tests and unnecessary treatments.

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Superior mesenteric artery syndrome (Wilkie’s syndrome): acute severe presentation in a 10 year old boy and role of early surgical management

Journal of Pediatrics & Neonatal Care ◽

10.15406/jpnc.2018.08.00342 ◽

2018 ◽

Vol 8 (5) ◽

Author(s):

Rajat Piplani

Keyword(s):

Superior Mesenteric Artery ◽

Surgical Management ◽

Mesenteric Artery ◽

Superior Mesenteric Artery Syndrome ◽

Wilkie’S Syndrome

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Superior mesenteric artery (SMA) syndrome: an unusual cause of intestinal obstruction in palliative care

Annals of Palliative Medicine ◽

10.21037/apm.2016.07.03 ◽

2017 ◽

Vol 6 (1) ◽

pp. 91-93 ◽

Cited By ~ 1

Author(s):

Chun-Yan So ◽

Kwok-Ying Chan ◽

Ho-Yan Au ◽

Man-Lui Chan ◽

Theresa Lai

Keyword(s):

Palliative Care ◽

Intestinal Obstruction ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Sma Syndrome

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A clinical course of a patient with anorexia nervosa receiving surgery for superior mesenteric artery syndrome

Journal of Eating Disorders ◽

10.1186/s40337-021-00436-2 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Ken Kurisu ◽

Yukari Yamanaka ◽

Tadahiro Yamazaki ◽

Ryo Yoneda ◽

Makoto Otani ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Anorexia Nervosa ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Rare Complication ◽

Nutrition Therapy ◽

Psychological Status ◽

Sma Syndrome

Abstract Background Superior mesenteric artery (SMA) syndrome is a well-known but relatively rare complication of anorexia nervosa. Although several reports have proposed surgery for SMA syndrome associated with anorexia nervosa, these have shown poor outcomes or did not reveal the long-term weight course. Thus, the long-term effectiveness of surgery for SMA syndrome in such cases remains unclear. This case report describes a patient with anorexia nervosa who underwent surgery for SMA syndrome. Case presentation An 18-year-old woman presented with anorexia nervosa when she was 16 years old. She also presented with SMA syndrome, which seemed to be caused by weight loss due to the eating disorder. Nutrition therapy initially improved her body weight, but she ceased treatment. She reported that symptoms related to SMA syndrome had led to her weight loss and desired to undergo surgery. Laparoscopic duodenojejunostomy was performed, but her body weight did not improve after the surgery. The patient eventually received conservative nutritional treatment along with psychological approaches, which led to an improvement in her body weight. Conclusions The case implies that surgery for SMA syndrome in patients with anorexia nervosa is ineffective for long-term weight recovery and that conservative treatment can sufficiently improve body weight; this is consistent with the lack of evidence on the topic and reports on potential complications of surgery. Due to difficulties in assessing psychological status, consultation with specialists on eating disorders is necessary for treating patients with severely low body weight.

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Wilkie’s Syndrome Following Weight Loss in a Trauma Patient

Surgical Case Reports ◽

10.31487/j.scr.2020.10.06 ◽

2020 ◽

pp. 1-3

Author(s):

George Oosthuizen ◽

George Oosthuizen

Keyword(s):

Weight Loss ◽

Trauma Patient ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Treatment Options ◽

Rare Condition ◽

Feeding Tube ◽

Significant Weight Loss ◽

The Third ◽

Wilkie’S Syndrome

Wilkie’s syndrome, or superior mesenteric artery syndrome, is a rare condition of duodenal obstruction caused by compression of the superior mesenteric artery on the third part of the duodenum. The diagnosis should be considered in a patient who has experienced significant weight loss and now presents with persistent vomiting, especially if the vomiting occurs with the patient in the supine position and is alleviated by the lateral or prone position. The diagnosis can be confirmed by imaging studies demonstrating compression of the third part of the duodenum, and the main aim of treatment should be to pass a feeding tube beyond the point of obstruction to allow enteral feeding. The condition improves spontaneously with weight gain. Further treatment options include parenteral feeding and operative bypass in select cases. Here we present a case of Wilkie’s syndrome in a trauma patient with significant weight loss, together with a review of the literature on this interesting topic.

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Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings

Gastroenterology Research and Practice ◽

10.1155/2018/1937416 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Emanuele Sinagra ◽

Dario Raimondo ◽

Domenico Albano ◽

Valentina Guarnotta ◽

Melania Blasco ◽

...

Keyword(s):

Weight Loss ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Control Group ◽

Diagnosis And Management ◽

Sma Syndrome ◽

Aortomesenteric Angle ◽

Cect Scan ◽

Enhanced Computed Tomography ◽

Aortomesenteric Distance

Background. The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required. Aims and Methods. This study aims at analyzing the clinical presentation, diagnosis, and management of SMA syndrome. Ten cases of SMA syndrome out of 2074 esophagogastroduodenoscopies were suspected. A contrast-enhanced computed tomography (CECT) scan was performed to confirm the diagnosis. After, a gastroenterologist and a nutritionist personalized the therapy. Furthermore, we compared the demographical, clinical, endoscopic, and radiological parameters of these cases with a control group consisting of 10 cases out of 2380 EGDS of initially suspected (but not radiologically confirmed) SMA over a follow-up 2-year period (2015-2016). Results. The prevalence of SMA syndrome was 0.005%. Median age and body mass index were 23.5 years and 21.5 kg/m2, respectively. Symptoms developed between 6 and 24 months. Median aortomesenteric angle and aorta-SMA distance were 22 and 6 mm, respectively. All patients improved on conservative treatment. In our series, a marked (>5 kg) weight loss (p=0.006) and a long-standing presentation (more than six months in 80% of patients) (p=0.002) are significantly related to a diagnosis of confirmed SMA syndrome at CECT after an endoscopic suspicion. A “resembling postprandial distress syndrome dyspepsia” presentation may be helpful to the endoscopist in suspecting a latent SMA syndrome (p=0.02). The narrowing of both the aortomesenteric angle (p=0.001) and the aortomesenteric distance (p<0.001) was significantly associated with the diagnosis of SMA after an endoscopic suspicion; however, the narrowing of the aortomesenteric distance seemed to be more accurate, rather than the narrowing of the aortomesenteric angle. Conclusion. SMA syndrome represents a diagnostic and therapeutic challenge. Our results show the following findings: the importance of the endoscopic suspicion of SMA syndrome; the preponderance of a long-standing and chronic onset; a female preponderance; the importance of the nutritional counseling for the treatment; no need of surgical intervention; and better diagnostic accuracy of the narrowing of the aorta-SMA distance. Larger prospective studies are needed to clarify the best diagnosis and management of the SMA syndrome.

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