PICTURES IN DIGESTIVE PATHOLOGY

Wilkie’s syndromeCarlos 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

1130-0108/2017/109/1/62-63REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS© Copyright 2017. SEPD y © ARÁN EDICIONES, S.L.

REV ESP ENFERM DIG2017, Vol. 109, N.º 1, pp. 62-63

CASE REPORT

We report the case of a 14-year-old woman who pre-sented epigastric abdominal pain, abundant vomits and an important abdominal distension for some days. Previously, she had had similar episodes. She had not any signifi cant prior medical history. On examination, she presented dis-tended and tympanic abdomen, without peritoneal irri-tating sings. CT was performed and fi ndings resulted in diagnostic of Wilkie’s syndrome (Fig. 1). Conservative management was adopted. Subsequently, magnetic reso-nance angiography was performed (Fig. 2). After treat-ment, the patient was asymptomatic and presented oral tolerance (1).

DISCUSSION

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),

BB

Fig. 1. Axial CT images (A, B and C). Important dilation of stomach (*), transitional point on the third duodenal portion (green arrow) between AMS (blue arrow) and aorta (yellow arrow). Aorto-mesenteric angle: 6° (green lines), diminished distance between abdominal aorta and superior mesenteric artery.

A

B

C

Fig. 3. Volumetric reconstruction image which demonstrates collateral vascular circulation suggestive of previous similar episodes of partial intestinal obstruction.

Fig. 2. Axial (A and B) and sagittal (C) angiography images demons-trating resolution of the intestinal obstruction after conservative treatment, diminished distance between abdominal aorta (yellow arrow) and superior mesenteric artery (blue arrow), actually 5 mm.

A

B

C

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duodenal obstruction occurs (the normal angle ranges from 25° to 60° and the normal distance is 10 to 28 mm). In Wilkie’s syndromes both parameters are reduced (6° to 15° and 2 to 8 mm) (2).

Initially conservative management is adopted, but in some cases surgical treatment is necessary. Usually, in cas-es with acute presentation medical treatment is sufficient, while chronic evolution requires surgery after parenteral nutrition. In conclusion, surgery is indicated if conserva-tive management fails, in large evolution disease with sig-nificant 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 mesen-teric artery syndrome: diagnostic and therapeutic considerations. Rev Esp Enferm Dig 2013;105:236-8. DOI: 10.4321/S1130-0108201 3000400012

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