Wilkie's Syndrome as a Rare Cause of Duodenal Obstruction: Perspicacity Is in the Radiological Details

Faqeeh, Ahmad A Al; Syed, Muhammad Khalid; Ammar, Mohammed; Almas, Talal; Syed, Saifullah

doi:10.7759/cureus.10467

Cited by 7 publications

(7 citation statements)

References 11 publications

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“…The anterior NCS and SMAS (also known as Wilkie syndrome) may occur in case of reduction of the space between the SMA and the abdominal aorta (AA) (aortomesenteric distance <8 mm and aortomesenteric angle <22°) ( Fig. 1 c and d) with respectively compression of left renal vein (LRV) and third portion of duodenum [3 , 8 , 9] .…”

Section: Introductionmentioning

confidence: 99%

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

Farina¹,

Gozzo²,

Foti³

et al. 2021

Radiology Case Reports

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Median arcuate ligament syndrome and superior mesenteric artery syndrome are well-known abdominal compression syndromes, the coexistence of which is rarely described in literature. In addition, due to the common pathogenesis, anterior nutcracker syndrome may occur simultaneously to superior mesenteric artery syndrome. To our knowledge, this is the first case reporting combination of these 3 syndromes detected with ultrasound, Computed Tomography and upper gastrointestinal fluoroscopic exam. A 69-year-old man came to our attention for rapid weight loss, postprandial epigastric pain and recurrent vomiting for at least 6 months. Doppler ultrasound showed both celiac artery and left renal vein stenosis with simultaneous left varicocele. Computed tomography showed a reduction of aortomesenteric space causing both left renal vein and duodenal stenosis, this latter confirmed by upper gastrointestinal fluoroscopic exam. The diagnosis of these three vascular compression syndromes (MALS, SMAS, and anterior NCS) has been formulated, based on clinical and imaging findings. We assumed that the postprandial crises caused by median arcuate ligament syndrome may induce a reduction of meals consumption and progressive weight loss which can be a cause of anterior nutcracker syndrome and superior mesenteric artery syndrome onset. Doppler ultrasound, in expert hands, allows to accurately diagnosing these syndromes which are often underestimated. Failure to recognize it and inadequate treatment could have serious consequences for patients' health.

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Section: Introductionmentioning

confidence: 99%

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

Farina¹,

Gozzo²,

Foti³

et al. 2021

Radiology Case Reports

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show abstract

“…Barium testing, abdominal x-ray, CT/CTA, MRI/MRA, and endoscopy play important roles in the diagnosis and differential diagnosis of SMAS ( 47 – 49 ). The main therapeutic goal is eliminating obstructions and obtaining optimal weight gains.…”

Section: Superior Mesenteric Artery Syndromementioning

confidence: 99%

Ultrasound characteristics of abdominal vascular compression syndromes

Liu,

Zheng,

Wang

et al. 2023

Front. Cardiovasc. Med.

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Abdominal vascular compression syndrome (AVCS) is caused by the compression of abdominal blood vessels by adjacent structures or the compression of abdominal organs by neighboring blood vessels. Such compressions can result in a variety of clinical symptoms. They are not commonly seen in ultrasound practices, and their presence may have been underrecognized and underdiagnosed. This article reviews the clinical features, ultrasound characteristics, and diagnostic criteria of four types of AVCS, namely, celiac artery compression syndrome, renal vein compression syndrome, iliac vein compression syndrome, and superior mesenteric artery syndrome to increase awareness of these conditions among ultrasound practitioners. The ultrasound criteria for AVCS are primarily based on studies with small sample sizes, and therefore, it is important to exercise caution if these criteria are used.

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“…Physiologically, the width of this angle ranges between 25° and 60° and the distance between the two blood vessels is 10-20 mm. 3 The therapeutic approach is often conservative and is based on nutritional support, which aims to increase the mesenteric fat pad and the aortomesenteric angle. If this treatment approach fails, surgery is indicated.…”

Section: Introductionmentioning

confidence: 99%

“…Physiologically, the width of this angle ranges between 25° and 60° and the distance between the two blood vessels is 10–20 mm. 3 …”

Section: Introductionmentioning

confidence: 99%

Aorto–mesenteric compass syndrome (Wilkie’s syndrome) in the differential diagnosis of chronic abdominal pain

Forte,

Santarpia,

Venetucci

et al. 2023

BMJ Case Rep

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A woman in her 40s was admitted to hospital with weight loss, asthenia, persistent abdominal pain and post-prandial nausea and vomiting. Other comorbidities were anxiety-depressive disorder, gastro-oesophageal reflux disease and fibrocystic mastopathy. On admission her body mass index (BMI) was 15.57 kg/m2with a reported weight loss of 6 kg during the last 3 months. The patient underwent a double contrast abdominal CT scan, which showed that the third portion of the duodenum appeared to be compressed between the superior mesenteric artery and the abdominal aorta. After a multidisciplinary evaluation, a conservative approach and nutritional supplementation was decided upon and administered. At the 1-year follow-up the symptoms had greatly improved; the epigastric pain, although persistent, was reduced, also due to the weight gain to 50 kg (BMI 19.5 kg/m2). Wilkie’s syndrome, in its acquired form, predominantly affects young women after rapid weight loss. In the diagnostic work-up, case history, physical examination and radiological findings play a key role.

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Wilkie's Syndrome as a Rare Cause of Duodenal Obstruction: Perspicacity Is in the Radiological Details

Cited by 7 publications

References 11 publications

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

Ultrasound characteristics of abdominal vascular compression syndromes

Aorto–mesenteric compass syndrome (Wilkie’s syndrome) in the differential diagnosis of chronic abdominal pain

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