2000, Number 4
PDF size: 324.73 Kb.
ABSTRACTObjective: To present the clinical case of a patient with vascular occlusion of the duodenum or superior mesenteric artery syndrome (Wilkie’s syndrome).
Design: Description of the case.
Setting: Third level health care hospital
Case description: A female patient, 18 years old, with posprandial abdominal pain at the epigastric region, colic-type, without irradiation accompanied by nausea, posprandial vomiting, and weight loss. Laboratory tests included blood tests, seric electrolytes, liver function tests; all were normal. Esophageal-gastric series revealed an abrupt interruption in the contrast medium flow at the level of the junction of the second and third portion of the duodenum; endoscopy revealed slight pangastritis; axial computed tomography showed thinning of the duodenal portion behind the superior mesenteric artery, and the selective angiography documented a retromesenteric space of 10.5 mm with the aorta-mesenteric angle at minimal normal levels. The patient was subjected to surgery, performing a latero-lateral duodenum-jejunum anastomosis; evolution was satisfactory.
Conclusion: The superior mesenteric syndrome is an infrequent alteration, its treatment is controversial. The most recommended procedure is to shunt the pre-stenotic portion of the duodenum to the jejunum.
Von Rokitanski C. Lerbuch der patologische Anatomie. Vienna: Braumuller 1861.
Akin TJ Jr, Gray SW, Skandalakis JE. Vascular compression of the duodenum: Surgery 1976;79:515-22
Wilkie DPD. Chronic duodenal ileus. Br J Surg 1921; 9: 204-214.
Wilkie DPD. Chronic duodenal ileus. Am J Med Sci 1927; 173: 643-9.
Barner HB, Sherman CD Jr. Vascular compression of the duodenum. Int Abstr Surg 1963; 117: 103-18.
Sabiston DC. Textbook of Surgery. Filadelfia W.B. Saunders, 1986: 874-880.
Akin JT Jr, Skandalakis JE, Gray SW. The anatomic basis of vascular compression of the duodenum. Surg Clin North Am 1974; 54: 1361-70.
Tapia A, Sharp A, Llanos O, Rahmer A, Zuñiga A. Síndrome de compresión vascular del duodeno. Comunicación de 2 casos. Rev Med Chil 1993; 121: 425-9.
Lundell L, Thulin A. Wilkie’s syndrome-a rarity? Br J Surge 1980; 7: 604-6.
Gersin KS, Heniford BT. Laparoscopic duodenojejunostomy for treatment of superior mesenteric artery syndrome. J Soc Laparoendosc Surg 1998; 8: 281-4.