Superior Mesenteric Artery syndrome or Wilkie’s syndrome

• Superior mesenteric artery syndrome is a rare condition in which obstruction of the 3rd portion of duodenum is produced by compression between the superior mesenteric vessels and the aorta.

Causes and pathophysiology

• The superior mesenteric artery normally leaves the aorta at an acute angle (-50-60°). Normally a mass of fat and lymphatics around the origin of SMA is believed to protect the duodenum from compression.
• Factors that may precipitate obstruction are-

1. Sudden weight loss following injury or bum
2. Rapid growth in height
3. Application of body casts
4. Supine immobilization

Clinical features

• The syndrome is seen in thin patients.
• Common in young adults, more common in females
• Symptoms include epigastric bloating and crampy pain after meals, relieved by vomiting or prone position.

Investigation

• Barium meal study
• Hypotonic duodenography is superior to barium meal
• CT scan with contrast

Management

• Conservative t/t
• Conservative t/t is successful in most cases associated with orthopedic condition. Treatment usually involves removal of plaster cast and mobilization of patient.
• Postural therapy : patient is advised to turn into prone or knee-elbow position after meals or when symptomatic.
• Surgery for patients not responding to conservative methods
• Duodenojejunostomy is done

Don’t Forget to Solve all the previous Year Question asked on Superior Mesentric Artery Syndrome