Epigastric Pain and Weight Loss – A Case of Wilkie’s Syndrom
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Superior mesenteric artery syndrome is a rare cause of upper gastrointestinal system obstruction and its diagnosis is often delayed. This syndrome should be suspected in the differential diagnosis of patients with persistent nausea, abdominal pain, and significant weight loss.

Superior mesenteric artery syndrome (SMA syndrome) or Wilkie’s syndrome is a rare etiology of duodenal obstruction due to compression of the third portion of the duodenum between the SMA and the aorta. The incidence ranges between 0.013 and 0.3%. In humans, the aorta–SMA angle ranges from 38° to 65° due to erect posture. The main anatomical feature of SMA syndrome is the narrowing of the aorta–SMA angle to <25° and, consequently, a decrease in the aortomesenteric distance to <10 mm.

Physical examination and laboratory findings are usually non-specific. Symptoms include nausea, vomiting, epigastric pain, postprandial discomfort, bloating and weight loss. Nevertheless, many imaging methods are useful for diagnosing the condition. A high clinical suspicion is of the utmost importance, particularly in patients with severe weight loss and symptoms of gastric distension, whose initial studies were inconclusive. The management of SMA syndrome is individualized; the physician may adopt a conservative treatment (with nutritional support) or manage it invasively with surgery.

A 46-year-old female patient presented to the outpatient clinic of our internal medicine department with a 2-year history of epigastric pain, nausea, early satiety and weight loss of 15 kg. Previous studies were inconclusive. The patient underwent computed tomography enterography and its findings were consistent with SMA syndrome. Currently, the patient is being followed by General Surgery and Nutrition and is under nutritional measures in order to optimize her body mass index to decrease possible surgical complications. This case report emphasizes the importance of clinical suspicion and careful investigation when considering less common etiologies for frequent gastrointestinal symptoms.

Source: https://www.ejcrim.com/index.php/EJCRIM/article/view/1557/2009