DX: Superior Mesenteric Artery (Wilkie's) Syndrome

Wilkie's syndrome has some peculiarity becasue of its rareness and also because of the important role of the radiologist to identify it for proper and rapid surgical approach.

Here are the findings:

CT revealed gas within a duodenal loop wich is also dilated but apparently there is no intra or extraluminal compression. We have to consider that in a normal setting, there is no gas in duodenum.Upper GI series confirmed the obstruction in the 3rd segment (horizontal) and dilation of the 2nd segment (vertical) of the duodenum. CT also showed a narrowing between abdominal aorta and superior mesenteric artery right in the passage of the duodenum consistent with Wilkie's. She underwent suergery that confirmed the duodenal impingement.

Superior mesenteric artery (SMA) syndrome is a very rare, life-threatening gastrovascular disorder characterized by a compression of the third portion of the duodenum by the abdominal aorta (AA) and the overlying superior mesenteric artery. The syndrome is typically caused by an angle of 6°-25° between the AA and the SMA, in comparison to the normal range of 38°-56°, due to a lack of retroperitoneal and visceral fat. In addition, the aortomesenteric distance is 2-8 millimeters, as opposed to the typical 10-20.

 It is also known as Wilkie's syndrome, cast syndrome, mesenteric root syndrome, chronic duodenal ileus and intermittent arterio-mesenteric occlusion.It is distinct from Nutcracker syndrome, which is the entrapment of the left renal vein between the AA and the SMA.

Until next time!..

http://en.wikipedia.org/wiki/Superior_mesenteric_artery_syndrome
http://emedicine.medscape.com/article/932220-overview#a0104