Gastrointestinal Obstruction Secondary to Wilkie's Syndrome: A Case Report of a Rare Clinical Presentation

Wilkie's syndrome, also known as superior mesenteric artery (SMA) syndrome, is a rare condition characterized by upper gastrointestinal (GI) obstruction caused by compression of the third duodenal portion between the SMA and the abdominal aorta. This report presents a case involving a young female patient who exhibited symptoms of bowel obstruction and a history of chronic malnutrition, loss of appetite, and a depressive disorder. Imaging modalities demonstrated duodenal and gastric dilatation, attributed to a stenosis at the third to fourth portions of the duodenum, due to external compression by the SMA related to significant mesenteric fat loss. After initial conservative management aimed at improving nutritional status, a surgical duodenojejunostomy was performed. The postoperative course was uneventful, and follow-up showed significant weight gain and symptom resolution. SMA syndrome may present as either acute or chronic intestinal obstruction, caused by a variety of risk factors. Differential diagnoses include motility disorders as well as other mechanical causes of duodenal obstruction, and diagnostic modalities include multiple endoscopic and imaging studies. Conservative treatment is preferred as the initial approach, aiming to promote weight gain and restore mesenteric fat, while surgical options are employed upon failure of initial measures. This case highlights that early recognition, appropriate optimization, and timely surgical intervention in high-risk patients can lead to excellent functional outcomes and significant weight recovery.