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SUPERIOR MESENTERIC ARTERY SYNDROME (SMAS) OR WILKIE’S SYNDROME: CASE REPORT
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Abstract
Background: Superior Mesenteric Artery Syndrome (SMAS), also known as Wilkie’s syndrome, is a rare cause of upper intestinal obstruction due to compression of the third portion of the duodenum between the superior mesenteric artery and the abdominal aorta. The condition often presents with nonspecific gastrointestinal symptoms, leading to diagnostic delay. Case Presentation: A 57-year-old male with no history of chronic disease presented with recurrent postprandial epigastric pain, nausea, vomiting, and a 6-kg weight loss over three months. Abdominal CT demonstrated compression of the third part of the duodenum by the superior mesenteric artery. The patient underwent laparoscopic surgery to mobilize the D3–D4 segments of the duodenum and the Treitz ligament, divide the jejunum, move the duodenojejunal loop to the right side of the superior mesenteric artery, and then perform a jejunojejunostomy. Postoperative recovery was uneventful; oral feeding was resumed within 3 hours, and the patient was discharged on postoperative day 4. Conclusion: Superior Mesenteric Artery Syndrome (SMAS) is an important differential diagnosis in patients with unexplained upper gastrointestinal obstruction, particularly in the presence of significant weight loss. Computed tomography is the most accurate imaging modality for diagnosis. Conservative management may be effective in acute cases; however, surgical intervention is indicated in chronic or refractory cases. Laparoscopic surgery to mobilize the D3–D4 segments of the duodenum and the Treitz ligament, divide the jejunum, move the duodenojejunal loop to the right side of the superior mesenteric artery, and then perform a jejunojejunostomy provides favorable outcomes, including reduced postoperative pain and shorter recovery time.
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Keywords
Superior Mesenteric Artery Syndrome, Wilkie’s Syndrome, Duodenal Obstruction, Laparoscopic Surgery, Case Report
References
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