WILKIE’S SYNDROME ASSOCIATED WITH AN INFRARENAL ABDOMINAL AORTIC ANEURYSM AS A RARE CAUSE OF INTESTINAL OBSTRUCTION: CASE REPORT joramartinezmar@unal.edu.co

PE034

WILKIE’S SYNDROME ASSOCIATED WITH AN INFRARENAL ABDOMINAL AORTIC ANEURYSM AS A RARE CAUSE OF INTESTINAL OBSTRUCTION: CASE REPORT

2

Colombia

Poster with Discussion

Superior mesenteric artery (SMA) syndrome, known as Wilkie’s syndrome, is a rare etiology of duodenal obstruction caused by extrinsic compression between the SMA and the abdominal aorta. It typically results from narrowing of the aortomesenteric angle and distance, most often due to loss of the mesenteric fat pad. While rare on its own, its association with an abdominal aortic aneurysm (AAA) is even more uncommon and can complicate both diagnosis and management.

A descriptive observational case report was conducted through retrospective review of the patient’s clinical records, diagnostic imaging, procedures, and surgical interventions to document this unusual cause of high intestinal obstruction and the management approach used.

An 82-year-old male with a history of hypothyroidism, hypertension, and chronic smoking was hospitalized for airway obstruction due to advanced laryngeal squamous cell carcinoma. During his hospital stay, he developed signs of high intestinal obstruction. A contrast-enhanced abdominal CT scan revealed a large infrarenal AAA (70 mm diameter), with a significantly reduced aortomesenteric angle (15.9°) and distance (5.3 mm), resulting in compression of the third portion of the duodenum. Imaging also showed marked gastric and duodenal dilation. Initial conservative treatment included nasogastric decompression, electrolyte correction, prokinetics, and parenteral nutrition. Due to the impracticality of vascular intervention, an open gastroyeyunostomy was performed.

Aortomesenteric compression should be considered in patients presenting with weight loss, persistent bilious vomiting, and abdominal distension. When associated with an AAA, overlapping mass effect further complicates the clinical scenario, demanding individualized and often complex surgical management strategies.