Gómez LA, Reyes MRA, Parra MA, Bedolla CP

Language: Spanish
References: 5
Page: 281-283
PDF size: 768.58 Kb.

ABSTRACT

Wilkie's syndrome, an uncommon cause of intestinal obstruction due to duodenal compression between the superior mesenteric artery and the aorta, presents a diagnostic challenge in critically ill patients because of its nonspecific presentation. We report the case of a previously healthy 25-year-old male who was admitted with severe traumatic brain injury secondary to a gunshot wound. After emergency surgery, he was admitted to the intensive care unit with enteral nutrition. Within 24 hours, he developed abdominal distension and high-output gastric drainage. Abdominal CT revealed gastric dilation and signs of duodenal obstruction, confirmed by endoscopy. CT angiography showed a 5° aortomesenteric angle, consistent with Wilkie's syndrome. A nasojejunal tube was placed for distal enteral feeding, and surgical evaluation was requested. Family history revealed gastrointestinal symptoms since childhood, suggesting a previously undiagnosed subclinical form. This case highlights the importance of considering this syndrome in critically ill patients presenting with intestinal obstruction.

REFERENCES

1. Welsch T, Büchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg. 2007;24(3):149-156.

2. Ahmed AR, Taylor I. Superior mesenteric artery syndrome. Postgrad Med J. 1997;73(866):776-778.

3. Biank V, Werlin S. Superior mesenteric artery syndrome in children: a 20-year experience. J Pediatr Gastroenterol Nutr. 2006;42(5):522-525.

4. Neri S, Signorelli SS, Mondati E, Pulvirenti D, Campanile E, Di Pino L, et al. Ultrasound imaging in diagnosis of superior mesenteric artery syndrome. J Intern Med. 2005;257(4):346-351.

5. Welsch T, Jauch KW, Kienle P. Surgical options in SMA syndrome. Zentralbl Chir. 2009;134(5):430-434.