Wilkie's Syndrome with Successful Nonsurgical Conservative Treatment in a Young Man: A Case Report.

Abstract

BACKGROUND Superior mesenteric artery syndrome, also known as Wilkie's syndrome, is a rare etiology of obstruction of the lower duodenum between the superior mesenteric artery and aorta. It often presents with unspecific abdominal pain and laboratory findings, resulting in difficult diagnosis and treatment. CASE REPORT A 21-year-old male patient was admitted to our clinic with a 13-month history of coughing, ill feeling, night sweats, vomiting, unintentional weight loss, and epigastric pain. Despite recurrent referral, the diagnostic panels, including a full abdominal laboratory workup, were unremarkable, with the following results: pancreatic amylase: 34.6 U/L, pancreatic lipase: 22 U/L, bilirubin: 0.66 mg/dL, aspartate aminotransferase: 21 U/L, alanine aminotransferase: 40 U/L, white blood cells: 12.59×10⁹/L, plasma total protein: 8.4 g/dL, and hemoglobin: 14.7 g/dL. An abdominal computed tomography scan revealed a paucity of the mesenteric artery and subcutaneous fat, the dilation of the stomach and compression of the duodenum between the superior mesenteric artery and aorta, and an aorto-mesenteric distance of 5.1 mm, resembling superior mesenteric artery syndrome (Wilkie's syndrome). Conservative therapy, including high caloric nutritional support, was administered. A gastroscopy was performed to dilate the distal portion of the duodenum, to enable a physiological passage. The patient was discharged 5 days after diagnosis in good condition, with weight gain, and continued to receive regular follow-up with our outpatient department. CONCLUSIONS This case underlines the importance of considering rare etiologies of abdominal symptoms for concise diagnosis, along with the importance of considering nonsurgical treatment, especially in young patients.