Wilkie's syndrome as the cause of intestinal obstruction in an 18-year-old female adolescent: A case report.

Wilkie's syndrome, also known as superior mesenteric artery (SMA) syndrome, is an extremely rare clinical condition encountered in medical practice. It occurs when the third part of the duodenum is compressed between the SMA anteriorly and the aorta and vertebral column posteriorly, leading to partial or complete bowel obstruction. An 18-year-old female adolescent presented with a 2-week history of vomiting. She also complained of crampy abdominal pain and progressive abdominal distension of the same duration. Her symptoms began after she underwent an appendectomy for acute appendicitis. Upon presentation, she was in severe pain and tachycardic, with a pulse rate of 126 beats per minute. Examination revealed a distended abdomen with isolated epigastric tenderness. Plain abdominal radiography was performed and was suggestive of small bowel obstruction. A computed tomography scan of the abdomen was then done, which showed superior mesenteric artery syndrome (Wilkie's syndrome). After discussion with the patient and her family laparotomy was performed. Intraoperatively, the third part of the duodenum was found to be compressed between the superior mesenteric artery anteriorly and aorta and vertebral column posteriorly. A modified Strong's procedure was performed. Postoperatively, she remained stable, and after 5 days in the hospital, she was discharged with dietary advice. At her outpatient follow-up appointments at 2 and 4 weeks post-discharge, she showed clinical improvement, with no signs of malnutrition, and was subsequently discharged from follow-up. Despite being a rare cause of obstruction, Wilkie's syndrome should be considered as a differential diagnosis in patients with chronic illness or a history of prior surgery.