title: Superior mesenteric artery (Wilkie's) syndrome: a rare cause of upper gastrointestinal system obstruction.
abstract: Background Superior mesenteric artery syndrome (SMAS) results from the compression of the third part of the duodenum between the aorta and the proximal part of the superior mesenteric artery (SMA). Clinical presentation of SMAS is characterized by the dilatation of the proximal part of the third part of the duodenum. SMAS is a rare cause of the upper gastrointestinal system (UGS) obstruction. In this study, we aimed to present our clinical experience in the treatment of five patients with SMAS, which is a rare clinical condition requiring surgery. Patients and methods The retrospective study included five patients who were treated due to SMAS at our clinic between January 2010 and January 2014. Results All the patients were underweight, with a mean BMI of 15.73 (14-16). The clinical symptoms included epigastric pain after food intake, large volume bilious emesis, early satiety, failure to gain weight, indigestion, esophageal reflux, sense of fullness, and persistent weight loss. SMAS was diagnosed using barium meal studies, upper gastrointestinal endoscopy, abdominal ultrasonography, and CT angiography. Four patients underwent duodenojejunostomy and one patient was managed with gastrojejunostomy. No complication was observed during the postoperative period, and all the patients achieved significant improvement in symptoms. Conclusion SMAS is a rare cause of UGS obstruction, and the diagnosis of SMAS is often delayed. SMAS should be suspected in the differential diagnosis of the patients with unsubstantiated symptoms of persistent nausea, emesis, and significant weight loss.
authors.affiliation: a Department of General Surgery , Dicle University Medical Faculty , Diyarbakır , Turkey ;
authors.forename: Abdullah
authors.initials: A
authors.lastname: Oguz
authors.affiliation: a Department of General Surgery , Dicle University Medical Faculty , Diyarbakır , Turkey ;
authors.forename: Omer
authors.initials: O
authors.lastname: Uslukaya
authors.affiliation: a Department of General Surgery , Dicle University Medical Faculty , Diyarbakır , Turkey ;
authors.forename: Burak Veli
authors.initials: BV
authors.lastname: Ülger
authors.affiliation: a Department of General Surgery , Dicle University Medical Faculty , Diyarbakır , Turkey ;
authors.forename: Ahmet
authors.initials: A
authors.lastname: Turkoglu
authors.affiliation: a Department of General Surgery , Dicle University Medical Faculty , Diyarbakır , Turkey ;
authors.forename: Mehmet Veysi
authors.initials: MV
authors.lastname: Bahadır
authors.affiliation: a Department of General Surgery , Dicle University Medical Faculty , Diyarbakır , Turkey ;
authors.forename: Zubeyir
authors.initials: Z
authors.lastname: Bozdag
authors.affiliation: a Department of General Surgery , Dicle University Medical Faculty , Diyarbakır , Turkey ;
authors.forename: Abdullah
authors.initials: A
authors.lastname: Böyük
authors.affiliation: b Department of Radiology , Dicle University Medical Faculty , Diyarbakır , Turkey.
authors.forename: Cemil
authors.initials: C
authors.lastname: Göya
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D000792:Angiography / Q000379:methods; D004378:Duodenal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D035583:Rare Diseases; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D013478:Superior Mesenteric Artery Syndrome / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D055815:Young Adult
keywords: Duodenojejunostomy; emesis; nausea; superior mesenteric artery syndrome; weight loss