Wilkie’s Weight Loss Wonder: A Case Series

Abstract

INTRODUCTION Wilkie’s Syndrome, also known as Superior Mesenteric Artery Syndrome (SMAS), is a rare cause of bowel obstruction that can contribute to vague abdominal symptoms on clinical presentation. This syndrome occurs when the aortomesenteric angle decreases, compressing the third portion of the duodenum between the aorta and the superior mesenteric artery. An acute decrease in the mesenteric fat pad cushion between these two blood vessels is the primary etiology, although other causes (e.g., anatomical, postoperative, functional, and pubescent etiologies) have also been described. CASE PRESENTATION In the present cases, 2 females with a common history of recent weight loss presented to our institution with similar symptoms of abdominal pain, nausea and vomiting. Each patient was subsequently diagnosed with SMAS following imaging studies. Both patients experienced successful resolution of symptoms with conservative nutritional management. DISCUSSION Common presenting complaints of SMAS include nausea, vomiting, early satiety and postprandial pain. These symptoms overlap with other gastrointestinal disorders (i.e., mesenteric ischemia, intestinal volvulus, peptic ulcer disease) making diagnosis difficult. SMAS can be identified through imaging modalities including barium studies and computer tomography. First line therapies typically include conservative nutritional support and promotion of weight gain. If conservative therapies fail, various surgical procedures can be pursued. Delayed diagnosis can lead to further pathological sequelae, including duodenal compromise, ischemia and necrosis. As the syndrome progresses, success of conservative nutritional support is less likely, and surgical correction becomes increasingly necessary. CONCLUSION Therefore, a clinical goal for SMAS should include as swift a recognition and diagnosis as possible.

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“…A rare association has been reported after inferior vena cava (IVC) filter placement with a local inflammatory response and compression of the duodenum between the IVC and the SMA[ 17 ].…”

“…CT angiography measures the aortomesenteric angle and the distance between the two vessels. A normal aortomesenteric angle is between 25° and 87° with different subintervals in different reports[ 1 - 4 , 8 , 10 , 13 , 17 ]. The normal reported distance between the two vessels is 10 mm-34 mm[ 2 , 3 , 8 , 21 ], confirmed by imaging studies[ 8 ].…”

“…If the disease is unrecognized and left untreated, severe complications may occur, such as malnutrition, dehydration, electrolyte abnormalities, gastric pneumatosis and portal venous gas, gastric perforation, duodenal compromise, ischemia, necrosis[ 1 , 17 ], or gastrointestinal hemorrhage[ 1 ]. Patients with severe hypokalemia, metabolic alkalosis, and acute kidney injury resulting in cardiorespiratory arrest have also been described[ 29 ].…”

“…Retrospective studies have reported successful treatment of SMA syndrome in short-term follow-up with enteral nutrition[ 15 , 17 , 26 , 30 - 34 ]. After a mean period of 10 mo with enteral therapy, 65% of patients were without symptoms, while in 15%, their symptoms had improved.…”

“…However, as the syndrome progresses, nutritional support becomes less successful, and surgical correction is necessary[ 17 ]. Recently, many studies have suggested an earlier surgical approach, since prolonged medical therapy is associated with multiple admissions, a lower success rate, and increased disease recurrence.…”