Laparoscopic duodenojejunostomy for superior mesenteric artery (Wilkie's) syndrome in a 14-year-old girl: A case report

Introduction Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare cause of upper gastrointestinal obstruction in which the third part of the duodenum becomes compressed between the aorta and the SMA, often presenting with non-specific symptoms that delay diagnosis. Case presentation A 14-year-old girl presented with a two-year history of postprandial epigastric pain radiating to the left flank, early satiety, intermittent vomiting and an 8-kg weight loss. Previous evaluation at several hospitals had included diagnostic laparoscopy with appendectomy, gastroscopy, colonoscopy and contrast radiography; barium enema demonstrated transversoptosis interpreted as Payr's syndrome, and gastric emptying studies suggested gastroparesis. Abdominal CT angiography in our department demonstrated an acute aortomesenteric angle of approximately 25°, pre-stenotic dilation of the proximal duodenum (8.12 mm) and severe narrowing of the third portion of the duodenum to 1.85 mm at the aortomesenteric crossing, confirming SMA syndrome. After conservative management with parenteral and enteral nutrition failed to relieve symptoms, laparoscopic duodenojejunostomy was performed without complications. The patient resumed oral feeding on postoperative day 3 and was discharged on day 7. At three-month follow-up she had gained 9 kg with complete resolution of pain and postprandial vomiting. Conclusion SMA syndrome should be considered in the differential diagnosis of chronic abdominal pain with weight loss in adolescents. Laparoscopic duodenojejunostomy seems to provide rapid and durable symptom resolution when conservative therapy fails.

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