Presentation
A patient with a 3-year history of rheumatoid arthritis presented to the emergency room with upper central abdominal pain accompanied by postprandial fullness, nausea, and intermittent vomiting of 6 days duration that had worsened at the time of presentation.
Patient Data
A chest X-ray in the posteroanterior (PA) showed a marked gastric distention and the presence of gas-fluid levels at the duodenal level and an atelectasis in the right lower lobe.
An abdominal X-ray in the posteroanterior (PA) showed visualization of the stomach up to the iliac crests. Additionally, there was discernible air in the right colon and rectum.
Contrast-enhanced CT revealed a properly inserted nasogastric tube. However, it also indicated significant dilation and gas-fluid levels in the stomach, first, and second, with the collapse of the third and terminal portion of the duodenum.
Axial contrast-enhanced CT showed a significant dilation and gas-fluid levels on stomach, first, and second, with the collapse of the third and terminal portion of the duodenum.
Oblique-sagittal contrast-enhanced CT reveals vascular anatomy, with an acute aortomesenteric angle (AMA) of 20 degrees between the proximal superior mesenteric artery (SMA) and aorta, along with an aortomesenteric distance (AMD) of 6 millimeters.
Case Discussion
Wilkie syndrome is an acquired vascular compression disorder in which the acute angulation of the superior mesenteric artery results in the compression of the third part of the duodenum, leading to obstruction of the proximal bowel.
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