Wilkie syndrome (or superior mesenteric artery syndrome), also known by other names such as aortomesenteric duodenal compression, Cast syndrome and chronic duodenal ileus first observed in 1842 by Rokitansky, but first reported by Wilkie.1
Wilkie syndrome is a rare condition that results from vascular compression of the third part of the duodenum, in the angle between the descending aorta and the origin of the superior mesenteric artery (SMA). There is a cushion of fat and lymphatics around the SMA and due to rapid weight loss, the protective action of fat is lost. On sagittal section of CT abdomen, the normal aortomesenteric angle ranges from 25° to 60° and normal aortomesenteric distance ranges from 10 to 28 mm. However, in Wilkie syndrome both are reduced.2,3
Management consists of conservative maneuvers and surgery. Conservative measures include nasogastric decompression and frequent small meals in the left lateral or prone position (posturing maneuvers). Motility agents (eg, metoclopramide) may be helpful in some patients. Surgical options are considered when conservative maneuvers fail and include duodenojejunostomy (most common), Strong operation (mobilizing duodenum by dividing the ligament of Treitz) and transposition of the third part of duodenum anterior to the superior mesenteric vessels.4,5
REFERENCES
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