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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 2215663210.5144/0256-4947.2012.1116asm-6-659aWhat's Your Diagnosis?Answer: Wilkie syndrome Khalid Saifullah Khalid Mohd Ahmad Ibne Zaheer Samreen Jain Amit From the Department of Radiodiagnosis, Jawaharial Nehru Medical College & Hospital, AMU, Aligarh, IndiaCorrespondence: Dr. Saifullah Khalid, Radiodiagnosis, Jawaharial Nehru Medical College, House No.386-A, Street No.1 Iqra Colony Aligarh UP 202002 India, T: 09897218098, saif2k2@gmail.comNov-Dec 2012 32 6 1 1 Copyright © 2012, Annals of Saudi Medicine2012This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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Wilkie syndrome (or superior mesenteric artery syndrome), also known by other names such as aortomesenteric duodenal compression, Cast syndrome and chronic duodenal ileus first observed in 1842 by Rokitansky, but first reported by Wilkie.1

Wilkie syndrome is a rare condition that results from vascular compression of the third part of the duodenum, in the angle between the descending aorta and the origin of the superior mesenteric artery (SMA). There is a cushion of fat and lymphatics around the SMA and due to rapid weight loss, the protective action of fat is lost. On sagittal section of CT abdomen, the normal aortomesenteric angle ranges from 25° to 60° and normal aortomesenteric distance ranges from 10 to 28 mm. However, in Wilkie syndrome both are reduced.2,3

Management consists of conservative maneuvers and surgery. Conservative measures include nasogastric decompression and frequent small meals in the left lateral or prone position (posturing maneuvers). Motility agents (eg, metoclopramide) may be helpful in some patients. Surgical options are considered when conservative maneuvers fail and include duodenojejunostomy (most common), Strong operation (mobilizing duodenum by dividing the ligament of Treitz) and transposition of the third part of duodenum anterior to the superior mesenteric vessels.4,5
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REFERENCES
1 Wilkie D   Chronic duodenal ileus Br J Surg 1921 204 14 
2 Lippl F  Hannig C  Weiss W  Allescher HD  Classen M  Kurjak M   Superior mesenteric artery syndrome: diagnosis and treatment from the gastroenterologist’s view J Gastroenterol 2002 37 640 3 12203080 
3 Roy A  Gisel JJ  Roy V  Bouras EP   Superior mesenteric artery (Wilkie’s) syndrome as a result of cardiac cachexia J Gen Intern Med 2005 10 20 C3 4 16191148 
4 Welsch T  Büchler MW  Kienle P   Recalling superior mesenteric artery syndrome Dig Surg 2007 24 149 56 Epub 2007 Apr 27 17476104 
5 Hines JR  Gore RM  Ballantyne GH   Superior mesenteric artery syndrome. Diagnostic criteria and therapeutic approaches Am J Surg 1984 11 148 630 2 6496852