Superior Mesenteric Artery Syndrome: A Forgotten Cause of Duodenal Obstruction

Superior mesenteric artery syndrome in an 8-year-old boy: a case report

BACKGROUND

Superior mesenteric artery syndrome (SMAS), also known as Wilkie's syndrome, is a rare disease that mainly presents as intestinal obstruction with a variable incidence ranging from 0.013 to 0.3% (Salehzadeh et al. in Case Rep Gastrointest Med, 2019, 10.1155/2019/3458601). In this syndrome, the third part of the duodenum, located between the abdominal aorta and the superior mesenteric artery, is wholly or partially obstructed (Mosalli et al. in J Pediatr Surg 46:e29-31, 2011). Case presentation An 8-years-old Arabian male patient was admitted to the gastrointestinal department at the pediatric hospital in Damascus, Syria, with complaints of chronic abdominal pain and periodic vomiting since he was two years old. At the age of Seven, he was diagnosed with appendicitis, and after two months of persistent symptoms, he was diagnosed with an umbilical hernia. Finally, after a long time of suffering, he was diagnosed with SMAS and underwent a successful surgical operation. After 3 months of follow-up, he was in good health with no symptoms.

CONCLUSION

Whenever a patient complains of vomiting and chronic abdominal pain, intestinal obstruction is suspected, Common differential diagnoses were excluded and the cause is anonymous, we should consider superior mesenteric artery syndrome.

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

BACKGROUND

Superior mesenteric artery syndrome is a disease with a complex diagnosis, and it is associated with complications that make it even harder to identify. Currently, a frequent association with psychiatric disorders has been noted. Despite numerous case reports and case series, the variability of the disease has not allowed the development of protocols regarding diagnosis and management.

CASE SUMMARY

A 33-year-old woman presented with abdominal pain, nausea, and bile vomiting over the last 15 mo, associated with a 15-kg weight loss over the last three months. After the onset of the symptoms, the patient was diagnosed with anxiety-depressive disorder and treated appropriately. Standard examinations excluded an organic cause, and the cause of the symptoms was considered psychogenic. The persistence of symptoms, even under treatment, prompted a computer tomography angiography examination of the abdomen and pelvis. The examination identified emergence at a sharp angle of 13.7° of the superior mesenteric artery, with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm. A diagnosis of aortomesenteric clamp was established. Surgical treatment by laparoscopic duodenojejunostomy was performed. Postoperative evolution was marked by a patent anastomosis at 1 mo, with a 10-kg weight gain and improvement of the associated anxiety.

CONCLUSION

This case report underlines two major aspects. One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders, with an excellent outcome when proper treatment is administered. The second aspect underlines the key role of a multidisciplinary approach and follow-up.

Superior Mesenteric Artery Syndrome: A Community Hospital Case Series

Superior mesenteric artery syndrome is an obstruction of the small bowel between the aorta and the superior mesenteric artery. Patients with this disease are initially managed medically and those patients who fail medical treatment require surgery. A retrospective case series of thirteen patients diagnosed with SMAS at Flushing Hospital, Flushing, NY, from 2011 to 2020 was performed. Descriptive statistics were used to summarize the characteristics of the entire cohort, and comparative statistics were used to compare the patients who failed medical treatment and required surgery to those who were successfully managed medically. Nine patients were managed conservatively and four patients required operative intervention. BMI was significantly lower in patients requiring operation compared to those who were successfully managed medically. This retrospective community hospital case series adds to the literature on SMAS and provides evidence of BMI as a potential predictor of requiring surgery in SMAS.