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When the duodenum reaches a crossroad: Wilkie
EP33118
Poster Title: When the duodenum reaches a crossroad: Wilkie's syndrome.
Submitted on 10 Oct 2020
Author(s): Darío Herrán de la Gala, Teresa Cobo Ruiz, David Castanedo Vázquez, Pablo Sanz Bellón, Amaia Pérez del Barrio, Pablo Menéndez Fernández-Miranda, Carmen González-Carreró Sixto, Javier Azcona Sáenz, Elena Marín Díez, María Sáenz Aldea, Victor Fernández Lobo, Hector Vidal Trueba.
Affiliations: Santander, “Marqués de Valdecilla” University Hospital, Cantabria/Spain.
This poster was presented at BIR Annual Congress 2020
Poster Views: 121
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Poster Information
Abstract: Case presentation:
An 85-year-old male patient was admitted to the emergency department with epigastric pain alongside with vomiting and nausea. Physical examination revealed a marked left-upper-quadrant abdominal distension. Firstly, a supine (Figure 1A) and erect (Figure 1B) PA abdominal X ray was performed, which showed a noticeable gastric chamber distention and gas distribution suggestive of bowel obstruction.
The abdominal CT-scan (Figures 1C and 1D) showed an important dilation of the gastric chamber and the first two duodenal segments, with a caliber change at the superior mesenteric artery (SMA) with distally collapsed small-bowel loops. The study showed a retroaortic left renal vein as an anatomic variant.

Discussion:
Small bowel obstruction secondary to SMA syndrome (also known as Wilkie’s syndrome) was the final diagnosis. Conservative management with nasogastric tube placement was chosen, with clinical improvement.

Conclusion:
Wilkie’s syndrome is rare vascular compressive disease, prevailing in young women. Its caused by a compression of the third portion of the duodenum between the abdominal aorta and the SMA(1), due to the anomalous course of the SMA that originates with angle less than 22°(2), resulting in duodenal obstruction.
The main predisposing factors for the decrease of the aorto-mesenteric angle are weight loss and surgeries (most importantly correction of scoliosis)(2).
The anatomic crossroad between the SMA and the abdominal aorta must be scrutinized in abdominal imaging techniques.
Summary: Wilkie’s syndrome is rare vascular compressive disease, prevailing in young women . Its caused by a compression of the third portion of the duodenum between the abdominal aorta and the SMA, due to the
anomalous course of the SMA that originates with angle less than 22 22°, resulting in duodenal obstruction. The main predisposing factors for the decrease of the aorto mesenteric angle are weight loss and surgeries (most importantly correction of scoliosis).
References: 1. Gozzo C, Giambelluca D, Cannella R, Caruana G, Jukna A, Picone D, et al. CT imaging findings of abdominopelvic vascular compression syndromes: what the radiologist needs to know. Insights Imaging. 2020 Dec;11(1):48.
2. Welsch T, Büchler MW, Kienle P. Recalling Superior Mesenteric Artery Syndrome. Dig Surg. 2007;24(3):149–56.
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