Wilkie's syndrome

Síndrome de Wilkie o pinza aortomesentérica

Carlos Oliva-Fonte¹, Cristina Lidia Fernández-Rey², Javier Pereda-Rodríguez¹ and Ana María González-Fernández²

Departments of ¹Radiodiagnosis, and ²General Surgery and Digestive Diseases. Hospital General de Segovia. Segovia, Spain

Case report

We report the case of a 14-year-old woman who presented epigastric abdominal pain, abundant vomits and an important abdominal distension for some days. Previously, she had had similar episodes. She had not any significant prior medical history. On examination, she presented distended and tympanic abdomen, without peritoneal irritating sings. CT was performed and findings resulted in diagnostic of Wilkie's syndrome (Fig. 1). Conservative management was adopted. Subsequently, magnetic resonance angiography was performed (Fig. 2). After treatment, the patient was asymptomatic and presented oral tolerance (1).

Wilkie's syndrome is a rare condition that results from an intestinal obstruction due to compression of the third part of the duodenum between the abdominal aorta and the superior mesenteric artery. When the angle between both structures diminishes and the distance between the SMA and the aorta decreases (the most diagnostic value), duodenal obstruction occurs (the normal angle ranges from 25^o to 60^o and the normal distance is 10 to 28 mm). In Wilkie's syndromes both parameters are reduced (6^o to 15^o and 2 to 8 mm) (2).

Initially conservative management is adopted, but in some cases surgical treatment is necessary. Usually, in cases with acute presentation medical treatment is sufficient, while chronic evolution requires surgery after parenteral nutrition. In conclusion, surgery is indicated if conservative management fails, in large evolution disease with significant weight loss and progressive duodenal dilatation or after complications such as peptic ulcer secondary to obstruction.

References

1. Kennedy KV, Yela R, Achalandabaso M del M, et al. Superior mesenteric artery syndrome: diagnostic and therapeutic considerations. Rev Esp Enferm Dig 2013;105:236-8. DOI: 10.4321/S1130-0108201 3000400012.         [ Links ]

2. Bakker ME, Van Delft R, Vaessens NA, et al. Superior mesenteric artery syndrome in a 15-year-old boy during Ramadan. Eur J Pediatr 2014;173:1619-21. DOI: 10.1007/s00431-013-2190-5.         [ Links ]