Wilkie syndrome mimicking cholelithiasis

• DOI: https://doi.org/10.22533/at.ed.5157225300914

• Palavras-chave: Superior Mesenteric Artery Syndrome, Angioplasty, Intestinal Obstruction

• Keywords: Superior Mesenteric Artery Syndrome, Angioplasty, Intestinal Obstruction

• Abstract:

  Introduction: Superior mesenteric artery syndrome, also known as Wilkie syndrome (WS), is a rare and potentially serious condition characterized by compression of the duodenum by the superior mesenteric artery and aorta. This compression results in obstruction of the duodenum, often leading to symptoms such as vomiting, abdominal distension, and epigastric pain. The syndrome can be congenital or acquired. Conservative treatment, through dietary adjustments and positioning, is initially recommended, with surgery indicated when these methods fail or in cases with significant complications¹(,) ². Case Report: A 30-year-old female patient presented with a clinical picture of epigastric pain and heartburn for 3 months, with epigastric pain after eating, accompanied by a feeling of postprandial fullness. In addition, she reported anxiety disorder, insomnia, recent treatment for H. pylori, bilateral kidney stones, and cholelithiasis. Cholecystectomy was performed, but there was no improvement in symptoms. The patient was then treated with proton pump inhibitors, without success, and lost follow-up. Ten months after the onset of symptoms, she returned with persistent symptoms. An abdominal CT scan was performed, which showed gastric distension and a possible change in the aortomesenteric angle. Given the suspicion of WS, the patient underwent an angiotomography, which showed a reduced aortomesenteric angle of 15º and an aortomesenteric distance of 5.5 mm, confirming the syndrome. She started a high-calorie diet, but without success in obtaining remission of symptoms. Surgical treatment with duodenojejunostomy was proposed, but the patient refused due to the possibility of the surgery being performed via laparotomy. Given the refusal, as a minimally invasive alternative, it was decided to perform angioplasty of the superior mesenteric artery with stent placement in order to modify the angle of the superior mesenteric artery, which resulted in significant improvement of symptoms. Discussion: The symptomatic similarity between SW and cholelithiasis makes it necessary to perform imaging tests to rule out the main pathologies that cause abdominal pain in the upper abdomen, located in the upper right or epigastric quadrant, associated with postprandial fullness. ⁴ Conservative treatment, with a high-calorie diet and adjustment of body position, is effective in most cases³, which was not the case in this patient.  The literature recommends duodenojejunostomy as the most effective surgical approach, with a success rate of over 90%. Given the patient's refusal, a minimally invasive approach was chosen with stent placement in the superior mesenteric artery for treatment. Despite the success in treating this patient with the use of a stent, further research and clinical studies are needed to establish definitive protocols and evaluate the long-term efficacy of this therapeutic approach.