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Hasegawa N, Oka A, Awoniyi M, Yoshida Y, Tobita H, Ishimura N, Ishihara S. Dynamic ultrasonography for optimizing treatment position in superior mesenteric artery syndrome: Two case reports and review of literature. World J Gastroenterol 2024; 30:499-508. [PMID: 38414592 PMCID: PMC10895595 DOI: 10.3748/wjg.v30.i5.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta (SMA-Ao). Although the left lateral recumbent position is considered effective in the treatment of SMA syndrome, individual variations in the optimal patient position have been noted. In this report, we present two elderly cases of SMA syndrome that exhibited rapid recovery due to ultrasonographic dynamic evaluation of the optimal position for each patient. CASE SUMMARY Case 1: A 90-year-old man with nausea and vomiting. Following diagnosis of SMA syndrome by computed tomography (CT), ultrasonography (US) revealed the SMA-Ao distance in the supine position (4 mm), which slightly improved in the lateral position (5.7-7.0 mm) without the passage of duodenal contents. However, in the sitting position, the SMA-Ao distance was increased to 15 mm accompanied by improved content passage. Additionally, US indicated enhanced passage upon abdominal massage on the right side. By day 2, the patient could eat comfortably with the optimal position and massage. Case 2: An 87-year-old woman with vomiting. After the diagnosis of SMA syndrome and aspiration pneumonia by CT, dynamic US confirmed the optimal position (SMA-Ao distance was improved to 7 mm in forward-bent position, whereas it remained at 5 mm in the supine position). By day 7 when her pneumonia recovered, she could eat with the optimal position. CONCLUSION The optimal position for SMA syndrome varies among individuals. Dynamic US appears to be a valuable tool in improving patient outcomes.
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Affiliation(s)
- Nobuaki Hasegawa
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Muyiwa Awoniyi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Hepatology Section, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Yuri Yoshida
- Clinical Laboratory Division, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Hiroshi Tobita
- Division of Hepatology, Shimane University Hospital, Izumo 693-8501, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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Edem S, Goswami AG, Karki B, Acharya P, Chauhan U, Kumar N, Basu S. Superior Mesenteric Artery Syndrome as a Rare Cause of Postoperative Intractable Vomiting: A Case Report. Clin Exp Gastroenterol 2023; 16:101-105. [PMID: 37409311 PMCID: PMC10318104 DOI: 10.2147/ceg.s416391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023] Open
Abstract
Background Superior mesenteric artery syndrome is a very rare cause of proximal intestinal obstruction. The objective of this clinical case report is to highlight that this unusual condition can occur in the early postoperative period and medical management may completely cure the condition. Clinical Case A middle-aged female who was being treated for pulmonary tuberculosis underwent exploratory laparotomy with limited ileal resection and a loop ileostomy for multiple ileal perforations. Postoperatively, she was restarted on anti-tubercular drugs (ATD) but developed a drug reaction, recurrent bilious vomiting, and jaundice and ATD had to be stopped. But her vomiting did not abate and she progressively developed septicemia. An abdominal CT scan diagnosed Wilkie's syndrome, and she was managed non-operatively by decubitus, parenteral nutrition, and nasojejunal tube feeding supplemented with prokinetics and antibiotics. But her sepsis did not resolve. Intraoperative histopathology suggested Candida infection, and she recovered only after systemic antifungal therapy. Discussion Debilitation conditions like tuberculosis cause weight loss and loss of intra-abdominal fat pad, which is known to precipitate SMA syndrome. However, its presentation in the early post-operative period is rare. Symptoms may vary from non-specific abdominal fullness and weight loss to features of acute bowel obstruction. CECT of whole abdomen can help in confirming the diagnosis. SMA syndrome is often not considered in differential diagnosis and can delay treatment. Medical management is the mainstay treatment option, although surgery is reserved for cases, which fail medical treatment. Conclusion High suspicion is needed to diagnose SMA syndrome in the postoperative period, which precipitates with intractable bilious vomiting. Medical management may be curative. The precipitating factor for SMA syndrome should also be addressed to improve the overall patient outcome.
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Affiliation(s)
- Sanketh Edem
- Departments of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Aakansha Giri Goswami
- Departments of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Bibek Karki
- Departments of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Preeti Acharya
- Departments of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Udit Chauhan
- Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, India
| | - Navin Kumar
- Departments of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Somprakas Basu
- Departments of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
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Oka A, Awoniyi M, Hasegawa N, Yoshida Y, Tobita H, Ishimura N, Ishihara S. Superior mesenteric artery syndrome: Diagnosis and management. World J Clin Cases 2023; 11:3369-3384. [PMID: 37383896 PMCID: PMC10294176 DOI: 10.12998/wjcc.v11.i15.3369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/13/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
Superior mesenteric artery (SMA) syndrome (also known as Wilkie's syndrome, cast syndrome, or aorto-mesenteric compass syndrome) is an obstruction of the duodenum caused by extrinsic compression between the SMA and the aorta. The median age of patients is 23 years old (range 0-91 years old) and predominant in females over males with a ratio of 3:2. The symptoms are variable, consisting of postprandial abdominal pain, nausea and vomiting, early satiety, anorexia, and weight loss and can mimic anorexia nervosa or functional dyspepsia. Because recurrent vomiting leads to aspiration pneumonia or respiratory depression via metabolic alkalosis, early diagnosis is required. The useful diagnostic modalities are computed tomography as a standard tool and ultrasonography, which has advantages in safety and capability of real-time assessments of SMA mobility and duodenum passage. The initial treatment is usually conservative, including postural change, gastroduodenal decompression, and nutrient management (success rates: 70%-80%). If conservative therapy fails, surgical treatment (i.e., laparoscopic duodenojejunostomy) is recommended (success rates: 80%-100%).
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Affiliation(s)
- Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Muyiwa Awoniyi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Hepatology Section, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Nobuaki Hasegawa
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yuri Yoshida
- Clinical Laboratory Division, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Hiroshi Tobita
- Division of Hepatology, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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Barros LCTRD, Santos BMRTD, Ferreira GDSA, Gomes VMDS, Vieira LPB. Superior mesenteric artery syndrome in a patient with esophageal stenosis: A case report. World J Surg Proced 2022; 12:13-19. [DOI: 10.5412/wjsp.v12.i2.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/12/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome (SMAS) is a rare condition, characterized by duodenal obstruction caused by compression of its third part by the superior mesenteric artery (SMA). Most cases of SMAS are associated with weight loss, and the most frequent clinical manifestations are nausea, vomiting, postprandial fullness, and abdominal pain. Treatment of SMAS is usually conservative, consisting mainly of adequate nutritional support, but in refractory cases surgery may be necessary, with gastrojejunostomy and duodenojejunostomy being the most commonly performed procedures.
CASE SUMMARY We describe the case of a man in his forties with a pre-existing diagnosis of esophageal stricture due to sodium hydroxide ingestion, who suffered significant weight loss after replacement of his jejunostomy tube. He was admitted to the hospital due to pain and abdominal distension. A computerized tomography scan showed significant distension of the stomach and duodenum with narrowing of the duodenum at the point at which it is crossed by the superior mesenteric artery, thus establishing the diagnosis of SMAS. Due to the presence of the esophageal stricture, the patient was incapable of emesis; however, passage of a nasogastric tube for decompression was not possible. Considering the risk of gastric perforation due to distention, we opted for surgical treatment in the form of a surgical gastrojejunostomy after which he showed complete resolution of all symptoms and was discharged from the hospital 5 d after the procedure.
CONCLUSION Diagnosis of SMAS can be challenging in patients with esophageal stenosis, and risk of gastric perforation may preclude conservative treatment.
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Affiliation(s)
| | | | - Gustavo de Sousa Arantes Ferreira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Brasilia 70658-700, Distrito Federal, Brazil
- Department of General Surgery, Hospital Metropolitano Doutor Celio de Castro, Belo Horizonte 30620090, Minas Gerais, Brazil
| | - Vitoria Mikaelly da Silva Gomes
- Department of General Surgery, Hospital de Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte 31710350, Minas Gerais, Brazil
| | - Lorenna Paulinelli Bahia Vieira
- Department of General Surgery, Hospital de Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte 31710350, Minas Gerais, Brazil
- Department of General Surgery, Hospital Metropolitano Doutor Celio de Castro, Belo Horizonte 30620090, Minas Gerais, Brazil
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Apostu RC, Chira L, Colcear D, Lebovici A, Nagy G, Scurtu RR, Drasovean R. Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature. World J Clin Cases 2022; 10:1654-1666. [PMID: 35211606 PMCID: PMC8855252 DOI: 10.12998/wjcc.v10.i5.1654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/05/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome is a disease with a complex diagnosis, and it is associated with complications that make it even harder to identify. Currently, a frequent association with psychiatric disorders has been noted. Despite numerous case reports and case series, the variability of the disease has not allowed the development of protocols regarding diagnosis and management.
CASE SUMMARY A 33-year-old woman presented with abdominal pain, nausea, and bile vomiting over the last 15 mo, associated with a 15-kg weight loss over the last three months. After the onset of the symptoms, the patient was diagnosed with anxiety-depressive disorder and treated appropriately. Standard examinations excluded an organic cause, and the cause of the symptoms was considered psychogenic. The persistence of symptoms, even under treatment, prompted a computer tomography angiography examination of the abdomen and pelvis. The examination identified emergence at a sharp angle of 13.7° of the superior mesenteric artery, with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm. A diagnosis of aortomesenteric clamp was established. Surgical treatment by laparoscopic duodenojejunostomy was performed. Postoperative evolution was marked by a patent anastomosis at 1 mo, with a 10-kg weight gain and improvement of the associated anxiety.
CONCLUSION This case report underlines two major aspects. One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders, with an excellent outcome when proper treatment is administered. The second aspect underlines the key role of a multidisciplinary approach and follow-up.
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Affiliation(s)
- Raluca Cristina Apostu
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400001, Romania
| | - Lucian Chira
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400001, Romania
| | - Doina Colcear
- Department of Psychiatry, Clinical Infectious Disease Hospital, Cluj-Napoca 400000, Romania
| | - Andrei Lebovici
- Department of Radiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
| | - Georgiana Nagy
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, 400006, Romania
| | - Radu Razvan Scurtu
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400001, Romania
| | - Radu Drasovean
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400001, Romania
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Satish Kumar L, Kaundinya KB. A rare instance of Wilkie's syndrome in a young male during the holy month of Ramadan. Int J Surg Case Rep 2021; 80:105652. [PMID: 33631645 DOI: 10.1016/j.ijscr.2021.105652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 12/18/2022] Open
Abstract
This is a case report of a young male diagnosed with Superior Mesenteric Artery syndrome during the period of fasting during Ramadan. The purpose of this report is to support physicians in a way of considering this as a differential when their patient presents similarly because it is not exclusive only to anorexic persons and can occur in a population that is fasting as well. The method of management was conservative and this clarifies that surgery does not necessarily have to be the first line treatment.
Introduction and importance Wilkie’s syndrome[SMA(Superior Mesenteric Artery) syndrome or Cast syndrome]) is a unique and rare presentation which may be included in the differential diagnosis especially when a Gastric outlet obstruction is being investigated and there is a history of an associated element of rapid weight loss. The purpose of presenting this case report is its uniqueness given a history of intermittent fasting rather than the usual eating disorders. Case presentation A crescendo worsening of symptoms of intractable vomiting, inability to eat, upper abdominal gas bloating and post meal abdominal pain since one week in a patient during a period of fasting for the first time had been observed. Clinical discussion After initial resuscitation, an ultrasound abdomen and an abdominal x ray revealed a distended stomach and a nasogastric tube was immediately introduced to avoid aspiration. A CT scan of the abdomen with contrast revealed the compressed duodenum in the aortomesenteric angle and the diagnosis of SMA syndrome was confirmed. An upper gastrointestinal endoscopy was also done to rule out other causes and it was found to be normal. Conclusion In an acute presentation, the response to conservative management is remarkable and in the absence of any possible future reoccurrences the surgical options may be avoided. High index of suspicion, appropriate radiological diagnosis and stepwise treatment options may guide the troubled patient towards recovery in this rare presentation. A proper history taking is key in diagnosing such a condition and does not have to be limited to eating disorders, typically.
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Requena-López AA, Mata-Samperio BK, Cuadra-Reyes LA, Casillas-Vargas R. Wilkie's syndrome as a cause of bowel obstruction in adults: A case report. CIR CIR 2020; 88:185-188. [PMID: 32116320 DOI: 10.24875/ciru.19001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is one of the rarest causes of small bowel obstruction. Clinical case A 36-year-old female patient, with a medical history of diabetes mellitus type 2, arrived at the emergency department with upper intestinal obstruction; a study protocol is made, integrating the diagnosis of Wilkie's syndrome. We performed a laparoscopic duodenojejunostomy, the patient did well in the post-operative period. Conclusions Laparoscopic duodenojejunostomy is a practical option to treat Wilkie's syndrome. It provides definitive treatment with the advantages and benefits of minimally invasive surgery.
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Affiliation(s)
- Abner A Requena-López
- Departamento de Cirugía General, Centro Médico, Instituto de Seguridad Social del Estado de México (ISSEMyM), Ecatepec, Estado de México, México
| | - Brenda K Mata-Samperio
- Departamento de Cirugía General, Centro Médico, Instituto de Seguridad Social del Estado de México (ISSEMyM), Ecatepec, Estado de México, México
| | - Luis A Cuadra-Reyes
- Departamento de Cirugía General, Centro Médico, Instituto de Seguridad Social del Estado de México (ISSEMyM), Ecatepec, Estado de México, México
| | - Ricardo Casillas-Vargas
- Departamento de Cirugía General, Centro Médico, Instituto de Seguridad Social del Estado de México (ISSEMyM), Ecatepec, Estado de México, México
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Lima Silva A, Antunes D, Cordeiro E Cunha J, Nogueira R, Fernandes D, Salazar T, Madureira Pinto C. Epigastric Pain and Weight Loss - A Case of Wilkie's Syndrome. Eur J Case Rep Intern Med 2020; 7:001557. [PMID: 32399444 PMCID: PMC7213823 DOI: 10.12890/2020_001557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 11/08/2022] Open
Abstract
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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Affiliation(s)
- Ana Lima Silva
- Internal Medicine Department, Centro Hospitalar do Médio Ave, Unidade de Famalicão, Vila Nova de Famalicão, Portugal
| | - Daniela Antunes
- Internal Medicine Department, Centro Hospitalar do Médio Ave, Unidade de Famalicão, Vila Nova de Famalicão, Portugal
| | - Joana Cordeiro E Cunha
- Internal Medicine Department, Centro Hospitalar do Médio Ave, Unidade de Famalicão, Vila Nova de Famalicão, Portugal
| | - Renato Nogueira
- Internal Medicine Department, Centro Hospitalar do Médio Ave, Unidade de Famalicão, Vila Nova de Famalicão, Portugal
| | - Diana Fernandes
- Internal Medicine Department, Centro Hospitalar do Médio Ave, Unidade de Famalicão, Vila Nova de Famalicão, Portugal
| | - Tatiana Salazar
- Internal Medicine Department, Centro Hospitalar do Médio Ave, Unidade de Famalicão, Vila Nova de Famalicão, Portugal
| | - Carla Madureira Pinto
- Internal Medicine Department, Centro Hospitalar do Médio Ave, Unidade de Famalicão, Vila Nova de Famalicão, Portugal
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Abstract
The underlying etiologies of paediatric bowel obstruction are wide ranging. It can be divided into proximal and distal bowel obstruction. Amongst the different etiologies of the proximal bowel obstructions at the level of the duodenum, there are a few etiologies including duodenal atresia, internal hernias, intestinal malrotation, annular pancreas etc. Superior mesenteric artery syndrome is amongst one of these differential diagnoses which is more prevalent in the adolescent age group. We describe the imaging features of this entity and its demographics, imaging characteristics, treatment and prognosis.
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Affiliation(s)
- Perry Liew Jia Ren
- Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, Singapore
| | - Achint Gupta
- Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, Singapore
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Abstract
Introduction Wilkie's syndrome is a rare entity that presents as a chronic intestinal obstruction secondary to mechanical compression of the third portion of the duodenum due to a decreased aorto-mesenteric angle. This entity has a reported incidence of 0.012 to 2.4% and can lead to high morbidity and mortality; In addition, there are major controversies regarding its diagnosis and treatment, which is why the authors present a case report of a patient with a diagnosis of Wilkie's syndrome and its surgical management via laparoscopy. Methods A case of a patient with clinical and imaging manifestations of superior mesenteric artery syndrome is presented, along with acritical review of the literature, taking into account articles published in the PubMed and ScienceDirect databases during the past 8 years. Clinical case A 27-year-old patient with 20 years of abdominal pain that exacerbated one week before admission, with a clinical and imaging manifestations of Wilkie's syndrome. Patient presents refractoriness to medical management, which led to a surgical approach with laparoscopic duodenum-jejunostomy that was carried out without perioperative complications and satisfactory results. Discussion and conclusions The superior mesenteric artery syndrome is a rare entity that in some scenarios requires surgical management. The laparoscopic duodeno-jejunostomy is the procedure of choice to manage this entity as evidenced in our case, which is also consistent with what is reported in the world medical literature.
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Affiliation(s)
- Henry Martínez
- Servicio de Cirugía General, Hospital Universitario de la Samaritana, Bogotá, Colombia
| | | | | | - Mauricio Pedraza
- Servicio de Cirugía General, Universidad El Bosque, Bogotá, Colombia
| | - Luis F Cabrera
- Servicio de Cirugía General, Universidad El Bosque, Bogotá, Colombia
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Recio-Barbero M, Fuertes-Soriano S, Cabezas-Garduño J, López-Atanes M, Peña-Rotella A, Sáenz-Herrero M. Delayed Diagnosis of an Eating Disorder in a Male Patient With Superior Mesenteric Artery Syndrome: Results From a Case Study. Front Psychiatry 2019; 10:731. [PMID: 31681041 PMCID: PMC6803474 DOI: 10.3389/fpsyt.2019.00731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/12/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Eating disorders (EDs) are serious and life-threatening mental diseases characterized by abnormal or altered eating habits. The prevalence is variable, being influenced by diverse sociocultural factors. Historically, the prevalence of EDs has been higher in women (90%), although the incidence of these disorders in men appears to be increasing. In daily medical practice, when considering the presentation of other medical complications associated to the development of an ED, few is known about its real prevalence in men. Among them, some severe gastrointestinal complications that are rarely presented, such as the superior mesenteric artery syndrome (SMAS), can produce life-threatening results. Despite that, very few cases of men presenting this pathology are reported in literature. Case Presentation: A 38-year-old man without a history of psychiatric disease was admitted to the emergency department with nausea, abdominal pain, and severe malnutrition (body mass index 15.7 kg/m2). He was diagnosed with SMAS and was studied by multiple specialists on suspicion of a probable organic origin of his thinning. The suspected diagnosis of ED was rejected for months by some professionals, as well as by the patient and his family, until it was finally diagnosed with unspecified feeding and eating disorder (USFED). Conclusion: This case represents an example of diagnostic challenge where a delayed diagnosis of an ED in a male patient was made probably due to gender bias in clinical research and practice. In the literature, numerous reports were described in women diagnosed with SMAS with a previous diagnosis of an ED; however, few cases were found in men. In this clinical case, the patient suffered a significant diagnostic delay, probably due to the lack of diagnostic suspicion given by the differences in the prevalence and clinical presentation of EDs in women and men.
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Affiliation(s)
- María Recio-Barbero
- Department of Psychiatry, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,Department of Neurosciences, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Sara Fuertes-Soriano
- Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Janire Cabezas-Garduño
- Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Mayte López-Atanes
- Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Alvar Peña-Rotella
- Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Margarita Sáenz-Herrero
- Department of Psychiatry, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,Department of Neurosciences, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain.,Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
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Aneiros Castro B, Cano Novillo I, García Vázquez A, Martín Alelu R, Gómez Fraile A. Wilkie's syndrome in monozygotic twins treated by 3-D laparoscopic duodenojejunostomy. Asian J Endosc Surg 2019; 12:125-127. [PMID: 29673098 DOI: 10.1111/ases.12489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/12/2018] [Indexed: 12/23/2022]
Abstract
Superior mesenteric artery syndrome, also known as Wilkie's syndrome, is a rare cause of proximal duodenum obstruction in children. Here, we describe the first pediatric case of superior mesenteric artery syndrome in monozygotic twin brothers. Both patients underwent 3-D laparoscopic duodenojejunostomy at the same age with an uneventful recovery.
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Bhatt S, Mishra B, Tandon A, Manchanda S, Parthsarathy G. Superior Mesenteric Artery Syndrome in association with Abdominal Tuberculosis: An Eye Opener. Malays J Med Sci 2017; 24:96-100. [PMID: 28814938 DOI: 10.21315/mjms2017.24.3.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/28/2016] [Indexed: 10/19/2022] Open
Abstract
Superior Mesenteric Artery Syndrome (SMAS) is a rare clinical entity presenting as acute or chronic upper gastrointestinal obstruction. It occurs due to compression of third part of duodenum between abdominal aorta and overlying superior mesenteric artery caused by a decrease in angle between the two vessels. Rapid loss of retroperitoneal fat, in conditions leading to severe weight loss is the main factor responsible for this disorder. Superior mesenteric artery syndrome in association with abdominal tuberculosis has not been reported earlier to the best of our knowledge. Therefore, an unknown cause (SMAS) of upper gastrointestinal obstruction in a patient of abdominal tuberculosis is being presented for the first time through this case report. An imaging diagnosis of SMAS was made on contrast enhanced CT abdomen which also confirmed the clinical suspicion of abdominal tuberculosis in the patient. The patient was managed conservatively and recovered without requiring any surgical intervention for the obstructive symptoms.
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Affiliation(s)
- Shuchi Bhatt
- Department of Radiodiagnosis, University College of Medical Sciences and GTB Hospital, Dilshad Garden, New Delhi, India
| | - Biswajit Mishra
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Anupama Tandon
- Department of Radiodiagnosis, University College of Medical Sciences and GTB Hospital, Dilshad Garden, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - G Parthsarathy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Farina R, Foti PV, Cocuzza G, Costanzo V, Costanzo G, Conti A, Torcitto A, Pennisi M. Wilkie's syndrome. J Ultrasound 2017; 20:339-342. [PMID: 29204239 DOI: 10.1007/s40477-017-0257-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022] Open
Abstract
Superior mesenteric artery syndrome, also known as Wilkie's syndrome, is a rare vascular disease caused by the anomalous course of the superior mesenteric artery arising from the abdominal aorta with a smaller angle than the norm (<22°). The reduced angle compresses the structures situated between the aorta and the superior mesenteric artery, such as the duodenum and left renal vein; this can determine painful crises, intestinal subocclusions, and left varicocele. This syndrome can be congenital or acquired. The acquired type is more common and is generally caused by reduced perivascular fat surrounding the abdominal aorta and the superior mesenteric artery; this form is common among anorexic patients that have had a rapid weight loss. We present the case of a female patient who suffered from repeated postprandial vomiting and who lost 12 kg in 4 months. B-mode ultrasound imaging revealed evidence of a reduced angle between the aorta and the superior mesenteric artery, as found in Wilkie's syndrome. After diagnosis, the patient followed a high-calorie diet, and 2 months later an ultrasound scan proved the restoration of the aorto-mesenteric angle as a consequence of increased perivascular fat with regression of symptoms.
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Affiliation(s)
- Renato Farina
- Radiodiagnostic and Radiotherapy, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123 Catania, Italy
| | - Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123 Catania, Italy
| | - Giuseppe Cocuzza
- Radiodiagnostic and Radiotherapy, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123 Catania, Italy
| | - Valeria Costanzo
- Radiodiagnostic and Radiotherapy, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123 Catania, Italy
| | - Giuliana Costanzo
- Radiodiagnostic and Radiotherapy, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123 Catania, Italy
| | - Alessandro Conti
- Radiodiagnostic and Radiotherapy, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123 Catania, Italy
| | - Alfredo Torcitto
- Radiodiagnostic and Radiotherapy, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123 Catania, Italy
| | - Monica Pennisi
- Radiodiagnostic and Radiotherapy, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123 Catania, Italy
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Khodear Y, Al-Ramli W, Bodnar Z. Laparoscopic management of a complicated case of Wilkie's syndrome: A case report. Int J Surg Case Rep 2017; 37:177-179. [PMID: 28688313 PMCID: PMC5501890 DOI: 10.1016/j.ijscr.2017.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/18/2017] [Accepted: 06/18/2017] [Indexed: 11/16/2022] Open
Abstract
Surgical intervention is the mainstay in complicated cases of SMA syndrome and in refractory cases to conservative management. Successful management of a complicated case of Wilkie’s Syndrome via duodenojeujenostomy is feasible using a laparoscopic approach. Advantages of laparoscopic approach over open surgery include rapid recovery time, reduced post-operative pain and shorter hospital stay.
Introduction Superior mesenteric artery (SMA) syndrome also known as Wilkie’s syndrome is a rare condition caused by the entrapment of the third part of the duodenum between the aorta and the SMA. The incidence of Wilkie’s syndrome range between 0.013% and 0.3%. The normal angle between the aorta and SMA has been described to range between 38° and 65°, whereas in Wilkie’s syndrome this angle is reduced to less than 20° causing gastric outlet obstruction. Case presentation We report a case of a previously diagnosed 43 year-old male with SMA syndrome, whom had been conservatively managed for 5-years for recurrent admissions with symptoms of gastric outlet obstruction. During his last admission, CT abdomen demonstrated gastric pneumatosis and portal venous gas requiring urgent surgical intervention. Duodenojejunostomy was successfully performed using laparoscopic technique. Discussion SMA syndrome is thought to occur secondary to the rapid and excessive weight loss leading to the reduction of the mesenteric fat around the aorta and SMA, thereby reducing the normal angle between the two arteries. Conservative medical management is usually the first line of treatment in uncomplicated cases. Surgical management is usually reserved only after failed conservative management or complicated cases, at which time either an open or laparoscopic surgical approach is undertaking. Conclusion Surgical intervention is the mainstay in complicated cases of SMA syndrome and in refractory cases to conservative management. Advantages of laparoscopic approach over open surgery include rapid recovery time, reduced post-operative pain and shorter hospital stay.
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Affiliation(s)
- Yehya Khodear
- Department of General Surgery, Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland.
| | - Wisam Al-Ramli
- Department of General Surgery, Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland.
| | - Zsolt Bodnar
- Department of General Surgery, Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
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Kaur A, Pawar NC, Singla S, Mohi JK, Sharma S. Superior Mesentric Artery Syndrome in a Patient with Subacute Intestinal Obstruction: A Case Report. J Clin Diagn Res 2016; 10:TD03-5. [PMID: 27504378 DOI: 10.7860/jcdr/2016/19699.7932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/25/2016] [Indexed: 11/24/2022]
Abstract
Superior Mesenteric Artery (SMA) syndrome is one of the rare cause of proximal small bowel obstruction wherein, the third part of the duodenum is compressed between the SMA at its origin and abdominal aorta due to decreased angulations in these two vessels. This decreased angulation exerts a compression effect on third part of the duodenum, resulting in duodenal obstruction which may be complete or partial. There are number of causes which can lead to this entity and will be discussed briefly. Here we report imaging findings of such a rare cause of proximal small bowel obstruction in a young male patient who presented to the emergency surgical department with non specific symptoms of pain abdomen and abdominal fullness. Patient was evaluated under the standard protocol in management of abdominal pain. General physical examination, erect and supine radiograph were taken. On barium meal follow-through examination, there was paucity of contrast agent distal to the second part of duodenum with proximal dilation of stomach, first and second part of duodenum which raised us the possibility of SMA syndrome. Reconstructed CECT abdomen confirmed the decreased angulation between SMA and abdominal aorta and diagnosed it as SMA syndrome. Findings were correlated on duodenojejunostomy anastomotic surgical procedure. Diagnosing and reporting such a case of SMA syndrome is of utmost importance because the clinical presentation being non-specific pertaining to small bowel obstruction which may pose a diagnostic difficulty to the surgeon and with the further delay in diagnosis, patients may end up with chronic symptoms and complications of the disease, repeated hospital visits and electrolyte abnormalities.
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Affiliation(s)
- Amarjit Kaur
- Professor, Department of Radiodiagnosis, GMC Patiala, Punjab, India
| | | | - Sonam Singla
- Junior Resident, Department of Radiodiagnosis, GMC , Patiala, Punjab, India
| | - Jaswinder Kaur Mohi
- Associate Professor, Department of Radiodiagnosis, GMC Patiala, Punjab, India
| | - Shivani Sharma
- Junior Resident, Department of Radiodiagnosis, GMC Patiala, Punjab, India
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Devadass CW, Okaly GVP, Hm S, Pai SA, Sridher H. Wilkie's Syndrome and Left Adnexal Mass: Unusual Presentation of Duodenal Adenocarcinoma. J Clin Diagn Res 2014; 8:FD01-2. [PMID: 25302201 DOI: 10.7860/jcdr/2014/9474.4693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/12/2014] [Indexed: 11/24/2022]
Abstract
Duodenal adenocarcinoma (DACa) is a rare malignancy, the presenting symptoms of which are vague and nonspecific. We report the case of a patient presenting with symptoms of subacute small bowel obstruction whose CT scan revealed i) left adnexal mass and ii) compression of 3(rd) portion of duodenum with reduced aortomesentric angle consistent with Wilkie's syndrome (WS). Laparatomy in addition revealed a distal duodenal stricture, which showed a well differentiated DACa causing subtotal intestinal obstruction. The ovarian mass revealed adenocarcinoma with similar morphology. Immunophenotypic analysis revealed positive expression of CK 20 and CDX 2 and absence of CK 7 staining in the tumours consistent with Primary DACa with ovarian metastasis. We further concluded that the WS resulted from reduced mesenteric fat pad caused by DACa induced cachexia. The case highlights the elusive nature of duodenal malignancy and emphasises the importance of meticulous small bowel examination during exploration of ovarian masses.
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Affiliation(s)
- Clement Wilfred Devadass
- Associate Professor, Department of Pathology, M.S., Ramaiah Medical College and Teaching Hospital , Bangalore, India
| | - Geetha V Patil Okaly
- Assistant Professor, Department of Pathology, M.S. Ramaiah Medical College and Teaching Hospital , Bangalore, India
| | - Sudha Hm
- Professor, Department of Pathology, M.S. Ramaiah Medical College and Teaching Hospital , Bangalore, India
| | - Sreekar Agumbe Pai
- Associate Professor, Department of Surgery, M.S. Ramaiah Medical College and Teaching Hospital , Bangalore, India
| | - H Sridher
- Assistant Professor, Department of Pathology, M.S., Ramaiah Medical College and Teaching Hospital , Bangalore, India
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Hussain Ashraf T, Chandra A, Jauhari RK, Kumar Singh S, Noushif M. Rosai-Dorfman disease with exclusive intra-abdominal lymphadenopathy masquerading as Wilkie's syndrome. Arab J Gastroenterol 2014; 15:40-1. [PMID: 24630515 DOI: 10.1016/j.ajg.2013.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 05/28/2013] [Indexed: 10/25/2022]
Abstract
Rosai-Dorfman disease is a rare histiocytic proliferative disorder with a distinctive microscopic appearance. Patients usually present with nonspecific symptoms and massive cervical lymphadenopathy. Exclusive involvement of intra-abdominal lymph nodes is unusual and presentation mimicking Wilkie's syndrome due to compression of the third part of the duodenum by enlarged retroduodenal lymph nodes is rare. This entity should be included in the differential diagnosis with infectious, granulomatous and malignant causes of intra-abdominal lymphadenopathy. We highlight an uncommon presentation and discuss the challenges in the diagnosis and management of Rosai-Dorfman disease.
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Affiliation(s)
- Tarique Hussain Ashraf
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Abhijit Chandra
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | | | - Sunil Kumar Singh
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - M Noushif
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Abstract
Primary carcinoma of the duodenum is rare. Here we present a case of megaduodenum due to duodenal adenocarcinoma mimicking Wilkie's syndrome which was managed by resection and anastomosis.
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