Summary about Disease
Wilkie's syndrome, also known as superior mesenteric artery (SMA) syndrome, is a rare digestive disorder characterized by compression of the third part of the duodenum (the first part of the small intestine) between the superior mesenteric artery (SMA) and the aorta. This compression causes partial or complete obstruction of the duodenum, leading to symptoms like nausea, vomiting, and abdominal pain.
Symptoms
Postprandial abdominal fullness and pain (pain after eating)
Nausea
Vomiting (often bilious, containing bile)
Early satiety (feeling full quickly)
Weight loss
Anorexia
Abdominal distension
Belching
Causes
The primary cause is a narrowed angle between the SMA and the aorta. This angle is normally 25-60 degrees, with a distance of 10-28 mm between the vessels. In Wilkie's syndrome, the angle can narrow to 6-15 degrees and the distance to 2-8 mm. This narrowing compresses the duodenum. Contributing factors include:
Significant weight loss, reducing the mesenteric fat pad that supports the SMA
Spinal surgery (particularly scoliosis correction)
Prolonged bed rest
Malnutrition
Congenital anatomical variations
Rapid growth spurts in adolescents
Medicine Used
Conservative Management: Metoclopramide or other prokinetic agents may be used to help with gastric emptying. Anti-emetics to control nausea and vomiting.
Nutritional Support: Parenteral nutrition (IV feeding) may be necessary if oral intake is insufficient.
Pain Management: Analgesics may be needed to manage abdominal pain.
Surgical Intervention: If conservative measures fail, surgery (e.g., Strong's procedure – duodenojejunostomy) may be required to bypass the obstruction.
Is Communicable
No, Wilkie's syndrome is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Maintain a healthy weight: Avoid rapid or excessive weight loss.
Proper posture: Maintain good posture to minimize compression.
Small, frequent meals: Eating smaller, more frequent meals can reduce the burden on the duodenum.
Avoid prolonged bed rest: If bed rest is necessary, take measures to prevent muscle wasting and maintain weight.
Early intervention: Seek medical attention promptly if symptoms develop.
How long does an outbreak last?
Wilkie's syndrome is not an outbreak-related illness. It's a chronic condition that can persist until treated. The duration of symptoms varies depending on the severity of the compression and the effectiveness of treatment. Without treatment, symptoms can be chronic and debilitating.
How is it diagnosed?
Upper GI series with small bowel follow-through: This involves drinking barium and taking X-rays to visualize the esophagus, stomach, and small intestine. It can show the obstruction in the duodenum.
CT scan with angiography: This imaging technique provides detailed views of the SMA and aorta, allowing measurement of the angle and distance between them.
MRI angiography: Another imaging option to visualize the SMA and aorta without radiation.
Duodenoscopy: Direct visualization of the duodenum with an endoscope.
Timeline of Symptoms
The onset of symptoms can be gradual or sudden, depending on the underlying cause and the degree of duodenal compression.
Early Stage: Intermittent abdominal discomfort, nausea, and early satiety.
Progressive Stage: Symptoms become more frequent and severe. Vomiting occurs more often, and weight loss becomes noticeable.
Advanced Stage: Constant abdominal pain, severe vomiting, significant weight loss, electrolyte imbalances, and potential for dehydration and malnutrition.
Important Considerations
Wilkie's syndrome is often misdiagnosed due to its rarity and nonspecific symptoms.
Early diagnosis and treatment are crucial to prevent complications such as malnutrition, electrolyte imbalances, and gastric dilation.
Treatment approaches vary depending on the severity of the condition and individual patient factors.
Surgical intervention may be necessary if conservative measures are unsuccessful.
Nutritional support is essential to restore and maintain adequate nutrition.