Wilkie's syndrome: a rare cause of intestinal obstruction.

To cite: Zachariah SK. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013203059 DESCRIPTION A 31-year-old woman was referred to our hospital, with recurrent episodes of profuse vomiting and upper abdominal pain associated with loss of appetite and dyspepsia since 2 months. She had no other comorbidities. She had been treated at another hospital with proton pump inhibitors, analgesics and intravenous fluids. She had a history of chronic anorexia and progressive loss of weight along with recurrent episodes of vomiting and upper abdominal pain. Clinical examination revealed dehydration, asthenicity (body mass index 18.8 kg/m), abdominal distension, epigastric tenderness and positive suction splash on auscultation. Laboratory investigations showed a total white cell count of 13 500mm and hypokalaemia (serum potassium: 3 mEq/L). Plain radiograph of the abdomen revealed gastric dilation. Ultrasonography was unremarkable. Upper gastrointestinal endoscopy showed dilated stomach and proximal capacious duodenum. Contrast-enhanced CT (CECT) scan revealed grossly distended stomach and duodenum proximal to the third part of the duodenum at the level of the origin of superior mesenteric artery with abrupt narrowing at this level, suggestive of superior mesenteric artery syndrome/Wilkie’s syndrome (figure 1). As conservative treatment failed, the patient underwent laparotomy after 10 days. At laparotomy, the stomach and the first and second parts of the duodenum were found to be greatly dilated and the offending superior mesenteric artery was seen clearly compressing the third part Figure 1 CT scan showing dilated stomach along with the first and second parts of the duodenum (D1 and D2). Calcifications can be seen within superior mesenteric artery (black arrow) and the aorta (white arrow).