Wilkie's syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

Abstract

Background: Superior mesenteric artery syndrome is a disease with a complex diagnosis, and it is associated with complications that make it even harder to identify. Currently, a frequent association with psychiatric disorders has been noted. Despite numerous case reports and case series, the variability of the disease has not allowed the development of protocols regarding diagnosis and management.

Case summary: A 33-year-old woman presented with abdominal pain, nausea, and bile vomiting over the last 15 mo, associated with a 15-kg weight loss over the last three months. After the onset of the symptoms, the patient was diagnosed with anxiety-depressive disorder and treated appropriately. Standard examinations excluded an organic cause, and the cause of the symptoms was considered psychogenic. The persistence of symptoms, even under treatment, prompted a computer tomography angiography examination of the abdomen and pelvis. The examination identified emergence at a sharp angle of 13.7° of the superior mesenteric artery, with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm. A diagnosis of aortomesenteric clamp was established. Surgical treatment by laparoscopic duodenojejunostomy was performed. Postoperative evolution was marked by a patent anastomosis at 1 mo, with a 10-kg weight gain and improvement of the associated anxiety.

Conclusion: This case report underlines two major aspects. One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders, with an excellent outcome when proper treatment is administered. The second aspect underlines the key role of a multidisciplinary approach and follow-up.

Keywords: Anxiety-depressive disorder; Case report; Duodenojejunostomy; Laparoscopy; Weight loss; Wilkie’s syndrome.

Figure 1

Angio-computed tomography images. A: Reduced distance between the superior mesenteric artery (SMA) and the anterior wall of the aorta up to a maximum of 8.05 mm; B: Emergence at a sharp angle of 13.7° of the SMA.

Figure 2

Exploratory laparoscopy. A: Dilated duodenum in the first and second parts; B: A collapsed third part beyond the mesenteric pedicle.

Figure 3

Laparoscopic duodenojejunostomy. A: Threaded spotting of the two enteral segments for the anastomosis; B: Side-to-side duodenojejunostomy using a 60 mm endoscopic liner articulated stapler.

Figure 4

Final aspect of the anastomosis after closing the common enterotomy.

Figure 5

Postoperative aspect of the abdomen at 1 mo evaluation, with 10 kg weight gain.

Figure 6

Oral gastrografin study. A: Free passage of the contrast through the anastomosis in the small bowel; B: Contraction of the stomach and duodenum.