RECURRENT SUPERIOR MESENTERIC-ARTERY (WILKIES) SYNDROME - A CASE-REPORT

Superior mesenteric artery syndrome (SMAS) is a rare condition. The di agnosis is usually made by exclusion. A previously healthy 20-year-old woman who had recurrent SMAS is described. Diagnosis of the condition was difficult. Initially, small-bowel enteroclysis, upper gastrointes tinal series and endoscopy, biopsy of gastric and duodenal mucosa, abd ominal computed tomography (CT) and ultrasonography were used to make the diagnosis. Abdominal CT suggested pancreatitis causing compressive obstruction of the superior mesenteric artery. Conservative managemen t was helpful at first, but cramping and projectile emesis recurred. U pper gastrointestinal series suggested duodenal distension and a filli ng defect in the region of the superior mesenteric artery. Repeat endo scopy showed a lateral pulsatile compression in the region of the dist al duodenum and SMAS was diagnosed. Medical therapy was not helpful so duodenojejunostomy was carried out. The operation was successful and the patient was symptom-free for 1 year, when the syndrome recurred, w ith symptoms of periumbilical pain, intermittent episodes of vomiting and loose stools. At reoperation the duodenojejunal anastomosis was fo und to be displaced to the left of the superior mesenteric artery pedi cle causing recurrent obstruction. The duodenojejunostomy was converte d to a Roux-en-Y duodenojejunostomy. The patient has since remained we ll. A MEDLINE search of the literature for the period 1961 to October 1994 revealed that there were no reported cases of a recurrence of SMA S in an otherwise healthy adult patient. In spite of the difficulty in diagnosing this condition, heightened awareness can lead to early dia gnosis and avoid unnecessary suffering for the patient.