Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1654
Peer-review started: August 13, 2021
First decision: October 20, 2021
Revised: November 5, 2021
Accepted: December 31, 2021
Article in press: December 31, 2021
Published online: February 16, 2022
Processing time: 181 Days and 22.5 Hours
Superior mesenteric artery syndrome is a disease with a complex diagnosis, and it is associated with complications that make it even harder to identify. Currently, a frequent association with psychiatric disorders has been noted. Despite numerous case reports and case series, the variability of the disease has not allowed the development of protocols regarding diagnosis and management.
A 33-year-old woman presented with abdominal pain, nausea, and bile vomiting over the last 15 mo, associated with a 15-kg weight loss over the last three months. After the onset of the symptoms, the patient was diagnosed with anxiety-depressive disorder and treated appropriately. Standard examinations excluded an organic cause, and the cause of the symptoms was considered psychogenic. The persistence of symptoms, even under treatment, prompted a computer tomography angiography examination of the abdomen and pelvis. The examination identified emergence at a sharp angle of 13.7° of the superior mesenteric artery, with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm. A diagnosis of aortomesenteric clamp was established. Surgical treatment by laparoscopic duodenojejunostomy was performed. Postoperative evolution was marked by a patent anastomosis at 1 mo, with a 10-kg weight gain and improvement of the associated anxiety.
This case report underlines two major aspects. One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders, with an excellent outcome when proper treatment is administered. The second aspect underlines the key role of a multidisciplinary approach and follow-up.
Core Tip: Wilkie’s syndrome is a rare vasculo-intestinal obstructive pathology that is difficult to diagnose due to nonspecific symptoms and the ability to mimic or coexist with other functional disorders. Its association with psychiatric eating disorders makes its differential diagnosis even more complex, allowing it to progress toward late, chronic stages. Untreated disease is associated with significant morbidity and mortality due to complications. It is important to consider its impact on psychosocial status and the appropriate approach to make an exclusion diagnosis.