Wilkie's syndrome in an adolescent female patient


  • Bandar Idrees A. Ali Department of Surgery, Prince Sultan Military Medical City, Riyadh
  • Khuloud Omar Bukhari 2Ministry of Health, Riyadh, Saudi Arabia
  • Abdullah Saeed Alzahrani Department of Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia




Superior mesenteric artery syndrome, Cast syndrome, Wilkie's syndrome, Mesenteric root syndrome


One of the rare cases of the upper gastrointestinal tract obstruction is superior mesenteric artery syndrome (SMAS) but potentially life-threatening if not recognized early. It is due to loss of fat pad between the aorta and SMA which will lead to a compression of the third portion of the duodenum. It has a different angle which will lead to different presentations as well as severity. We are reporting the 15 year-old (y/o) female who is medically free, presented to the emergency department (ED) complaining of severe colicky epigastric abdominal pain for the last 5 days in the epigastric area. The diagnosis of SMAS was made after clinical and radiological investigation. After proper supportive resuscitative measures, definitive management of the surgery was done by laparoscopic approach (duodenojejunostomy). The diagnosis of SMA syndrome is considered challenging due to many presentations and might be confused with other clinical conditions. Unless early diagnosed and treated, the outcome might be catastrophic. Medical treatment is attempted first in many cases depending on the severity and presentation but if failed, surgery will be the best option.


Metrics Loading ...

Author Biography

Bandar Idrees A. Ali, Department of Surgery, Prince Sultan Military Medical City, Riyadh

Department of surgery



Laffont I, Bensmail D, Rech C, Prigent G, Loubert G, Dizien O. Late superior mesenteric artery syndrome in paraplegia: case report and review. Spinal Cord. 2002;40(2):88-91.

Welsch T, Büchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg. 2007;24(3):149-56.

Rokitansky C. Handbuch der pathologischen anotomie. Vienna: Branmiller and Siedel. 1842.

Aljarad Z, Mahli N, Nasser M, Alobied M, Alkhaled M, Hamoud Alhussein MWH, et al. Superior Mesenteric Artery Syndrome Caused by Weight Loss in a Malnourished Syrian Man. Gastroenterol Rep. 2019;7:223-5.

Shetty AK, Schmidt-Sommerfeld E, Haymon ML, Udall JN. Radiologica case of the month: Denouement and discussion: Superior mesenteric artery syndrome. Arch Fam Med. 2000;9(1):17.

Choi JW, Lee JY, Cho HG. Superior Mesenteric Artery Syndrome Treated with Percutaneous Radiologic Gastrojejunostomy. Korean J Gastroenterol. 2016;67:321.

Roy A, Gisel JJ, Roy V, Bouras EP. Superior Mesenteric Artery (Wilkie’s) Syndrome as a Result of Cardiac Cachexia. J Gen Intern Med. 2005;20:3-4.

Falcone KL, Garrett KL. Superior Mesenteric Artery Syndrome After Blunt Abdominal Trauma: A Case Report. Vasc Endovascular Surg. 2010;44(5):410-2.

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

Iwaoka Y, Yamada M, Takehira Y, Hanajima K, Nakamura T, Murohisa G, et al. Superior mesenteric artery syndrome in indentical twin brothers. Intern Med. 2001;40:713.

Caspi B, Deutsch H, Grunshpan M, Flidel O, Hagay Z, Appelman Z. Prenatal manifestation of superior mesenteric artery syndrome. Prenat Diagn. 2003;23:932.

Akin JT, Gray SW, Skandalakis JE. Vascular Compression of the Duodenum: Presentation of Ten Cases and Review of the Literature. Surgery. 1976;79:515-22.

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;257:346-51.

Christopher TB, Mark AG. Unusual Causes of Recurrent Abdominal Pain. Emerg Med. 2006;38(5):11-8.

Murphy DJ, Aghayev A, Steigner ML. Vascular CT and MRI: a practical guide to imaging protocols. Insights Imaging. 2018;9:215-36.

Shin MS, Kim JY. Optimal duration of medical treatment in superior mesenteric artery syndrome in children. J Kor Med Sc. 2013;28(8):1220-5.

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

Merrett ND, Wilson RB, Cosman P, Biankin AV. Superior Mesenteric Artery Syndrome: Diagnosis and Treatment Strategies. J Gastrointest Surg. 2009;13:287.

da Costa KM, Saxena AK. Laparoscopic Options in Superior Mesenteric Artery Syndrome in Children: Systematic Review. J Pediatr Endosc Surg. 2019;1:53-7.

Baltazar U, Dunn J, Floresguerra C, Schmidt L, Browder W. Superior mesenteric artery syndrome: an uncommon cause of intestinal obstruction. South Med J. 2000;93(6):606-8.

Ylinen P, Kinnunen J, Höckerstedt K. Superior mesenteric artery syndrome. A follow-up study of 16 operated patients. J Clin Gastroenterol. 1989;11(4):386-91.






Case Reports