Superior Mesenteric Artery Syndrome (Wilkie Syndrome): Clinical Presentation, Management, and Outcomes from an Eight-Year Single-Center Experience
Abstract
Background: Superior Mesenteric Artery Syndrome (SMAS), also known as Wilkie syndrome, is a rare cause of proximal intestinal obstruction resulting from compression of the third portion of the duodenum between the abdominal aorta and the superior mesenteric artery. Owing to its nonspecific clinical presentation, diagnosis is frequently delayed, leading to prolonged nutritional deterioration and impaired quality of life. Methods: We conducted a retrospective descriptive study of all consecutive patients diagnosed with SMAS at the Department of Visceral Emergency Surgery, Ibn Rochd University Hospital, Casablanca, Morocco, between January 2018 and January 2026. Demographic characteristics, clinical presentation, radiological findings, management strategies, and clinical outcomes were analyzed. Results: Thirteen patients were included, with a mean age of 27 years (18– 41 years) and a female predominance (female-to-male ratio 1.6:1). Significant weight loss was observed in 84% of patients, with a mean body mass index of 18.2 kg/m2. The most common presenting symptoms were postprandial vomiting (92%), epigastric pain (85%), and features of proximal intestinal obstruction (54%). Contrast-enhanced computed tomography confirmed the diagnosis in all patients, demonstrating a mean aortomesenteric angle of 17° and a mean aortomesenteric distance of 6 mm. Conservative treatment was initiated in 77% of patients and was successful in 60% of cases. Seven patients underwent surgical treatment, predominantly laparoscopic duodenojejunostomy. No major postoperative complications or mortality were observed, and all operated patients experienced complete symptom resolution during follow-up. Conclusion: Superior Mesenteric Artery Syndrome should be considered in patients presenting with unexplained postprandial abdominal pain, recurrent vomiting, and significant weight loss. Contrast-enhanced CT remains the diagnostic gold standard. Conservative management should be the initial therapeutic approach, whereas laparoscopic duodenojejunostomy provides excellent outcomes in patients with persistent symptoms or failure of medical treatment.