Síndrome de Wilkie secundario a hipertiroidismo exógeno en una paciente con hipotiroidismo primario autoinmune: reporte de un caso y revisión de la literatura / Wilkie's syndrome caused by exogenous hyperthyroidism in a patient with primary autoimmune hypothyroidism: a case report and literature review

RESUMEN El síndrome de Wilkie o de arteria mesentérica superior es una causa poco común de obstrucción intestinal proximal, relacionada a pérdida de peso reciente. Reportamos el caso de una mujer de 19 años que se presenta a la clínica con pérdida de peso, dolor abdominal, nausea y vomito. Los exámenes de laboratorio reportaron anemia, hipoalbuminemia, hipomagnesemia y una hormona estimulante de la tiroides suprimida secundario al uso con levotiroxina. Se realizó una serie esofagogastroduodenal con datos compatibles con dilatación gástrica severa, gastroparesia y una tomografía axial computada reveló un ángulo aortomesentérico de 11,7°. Se inicio manejo conservador a base de nutrición enteral y parenteral total, siendo este el tratamiento de elección. En casos refractarios, la cirugía es una opción segura y efectiva.

ABSTRACT Wilkie's syndrome or superior mesenteric artery syndrome is an unusual cause of proximal intestinal obstruction, primarily attributed to recent weight loss. We report the case of a 19-year-old woman comes to our clinic and reports weight loss, abdominal pain, nausea, and vomiting. Laboratory tests revealed anemia, hypoalbuminemia, hypomagnesemia, and a suppressed thyroid stimulating hormone secondary to levothyroxine. A barium swallow test showed gastric dilatation, delayed gastric emptying and an axial computed tomography revealed an aortomesenteric angle of 11.7°. Conservative management with total parenteral and enteral nutrition was initiated, being the first-line treatment. In refractory cases surgery is a safe and effective option.

Rosai–Dorfman disease with exclusive intra-abdominal lymphadenopathy masquerading as Wilkie's syndrome

Rosai-Dorfman disease is a rare histiocytic proliferative disorder with a distinctive microscopic appearance. Patients usually present with nonspecific symptoms and massive cervical lymphadenopathy. Exclusive involvement of intra-abdominal lymph nodes is unusual and presentation mimicking Wilkie's syndrome due to compression of the third part of the duodenum by enlarged retroduodenal lymph nodes is rare. This entity should be included in the differential diagnosis with infectious, granulomatous and malignant causes of intra-abdominal lymphadenopathy. We highlight an uncommon presentation and discuss the challenges in the diagnosis and management of Rosai-Dorfman disease

Síndrome da artéria mesentérica superior: relato de caso / Superior mesenteric artery syndrome: case report

A síndrome da artéria mesentérica superior (SAMS) ou síndrome de Wilkie é uma afecção rara, caracterizada pela obstrução parcial ou completa da terceira porção do duodeno pela artéria mesentérica superior na face anterior, e pela aorta e coluna vertebral posteriormente. Apresentamos o caso de uma paciente que evoluiu no pós-operatório de colecistectomia com vômitos incoercíveis, pós-prandiais, não melhorados com antieméticos, sendo diagnosticado SAMS na avaliação complementar. Como paciente não apresentou resposta ao tratamento clínico, foi optado pelo tratamento cirúrgico. Atualmente sem complicações até o seguimento ambulatorial de 18 meses. A SAMS é uma causa incomum de obstrução duodenal, com sintomas inespecíficos, confirmada com exames contrastados, cujo diagnóstico depende do alto índice de suspeição da equipe médica.

The superior mesenteric artery syndrome (SAMS) or Wilkie syndrome is a rare condition characterized by partial or complete obstruction of the third portion of the duodenum by the superior mesenteric artery in the anteror face and by aorta and spine on the posterior face. The present case is grom a patient presenting after a colecistectomy with uncontrollable vomiting after meal, not improved with anti-emetics, being in a guether evaluation diagnosed in SAMS. As the patient did not respond to medical treatment, surgical treatment was chosen. After surgery the patient has be in gollowed for 18 months, completely asymptomatic. The SAMS is an uncommon cause of duodenal obstruction, wit nonspecific c symptoms, confirmed with contrast studies, whose diagnosis depends on a high index of suspicion of the medical team.

Síndrome de la arteria mesentérica superior (síndrome de Wilkie): caso clínico / Superior mesenteric artery syndrome (Wilkie syndrome): case report

El síndrome de la arteria mesentérica superior (síndrome de Wilkie) es una causa poco frecuente de obstrucción duodenal de origen vascular. Se asocia con situaciones que disminuyen elángulo entre la arteria mesentérica superior y la aorta (compásaortomesentérico) secundarias a pérdida de grasa retroperitoneal (descenso brusco de peso o caquexia) o procedimientos que determinan hiperextensión dorsal, especialmente enpostquirúrgicos de cirugía correctora de escoliosis. Clínicamente, se manifiesta por obstrucción intestinal alta. El diagnósticoes radiológico y el tratamiento es inicialmente médico. El tratamiento quirúrgico se reserva para casos refractarios. Se describe el caso de un paciente de 18 años con síndrome de Wilkie, secundario a cirugía correctora de escoliosis dorsolumbar. Con la sospecha clínica se realiza seriada gastroduodenal que confirma el diagnóstico. Inicia tratamiento médico con dieta hipercalórica fraccionada y medidas posturales con buena respuesta.

Syndrome of duodenal compression by the superior mesenteric artery following restorative proctocolectomy: a case report and review of literature

CONTEXTO: A proctocolectomia restaurativa com anastomose de bolsa ileal no canal anal é causa nova de desencadeamento da síndrome da compressão duodenal pela artéria mesentérica superior. A proctocolectomia restaurativa requer avaliação da posição do duodeno em relação ao pinçamento aortomesentérico para evitar a sua compressão pela artéria mesentérica superior. RELATO DE CASO: Os autores relatam um caso desta síndrome em doente com polipose adenomatosa familiar e realizam revisão da literatura no tocante à etiopatogênese, diagnóstico, tratamento e prevenção desta inusitada entidade.

Superior Mesenteric Artery Syndrome Due to an Aortic Aneurysm in a Renal Transplant Recipient

Superior mesenteric artery (SMA) syndrome is a rare disease in which the third portion of the duodenum is compressed by SMA. There are many causes leading to the SMA syndrome, however it's extremely rare that aortic aneurysm causes a SMA syndrome. We report a case of a successfully treated SMA syndrome due to an abdominal aortic aneurysm in a renal transplant recipient. The patient was a 52-yr-old woman with a thin stature (weight 40 kg, height 164 cm). She received a renal transplant 8 yr before, and had hypertension and abdominal aortic aneurysm. Her SMA syndrome developed in a prolonged supine position for the accidental rib fractures and was diagnosed by clinical and radiological findings. After a surgical correction (resection of an aneurysm and aortobiiliac bypass with an inverted Y graft), her symptoms relieved without deterioration of the graft function.

Superior mesenteric artery syndrome following ileo-anal pouch procedure.

A rare complication following ileo-anal pouch procedure is the occurrence of superior mesenteric artery syndrome. We report a patient with ulcerative colitis who developed vascular compression of the duodenum following J-pouch construction.

Anteriomesenteric duodenal compression syndrome

We report the case of a 48 year old man who presented with a 4 month history of vomiting and weight loss. Barium studies and upper gastrointestinal endoscopy demonstrated anteriomesenteric duodenal occlusion. We discuss the possible aetiology and significance of his investigation findings and subsequent management.

Complicaciones tardías en el lesionado medular / Late complications in the medullar wounded

Durante las últimas décadas, la sobrevida de los lesionados medulares ha registrado una marcada y continua prolongación. Debido a este hecho, el número de pacientes con lesión medular que llegan a edades avanzadas, ha presentado un importante incremento también. Sin embargo, el aumento de las expectativas de vida de estos pacientes ha traído consigo una mayor incidencia de complicaciones tardías, que progresivamente comienzan a adquirir mayor relevancia durante la evolución posterior a la injuria medular, dado que implican mayor discapacidad para el afectado. Los autores de este trabajo analizan las principales complicaciones tardías de los lesionados medulares, correspondientes a las que afectan a los sistemas nervioso, músculo-esquelético y gastrointestinal

Acute superior mesenteric artery syndrome due to rapid weight loss following massive small bowel resection.

Acute superior mesenteric artery syndrome is a rare condition and may follow rapid weight loss and immobilization. We present one such case due to rapid weight loss following massive small bowel resection.

Does helicobacter pylori share in superior mesenteric artery syndrome?

An association between superior mesenteric artery syndrome [SMAS] and peptic ulcer disease has been observed, the reason was unclear. Therefore we studied Helicobacter Pylori [HP] by rapid urease test [CLO] in endoscopic antral and duodenal biopsies of 21 dyspeptic patients with SMAS. All were asthenic, 18 females and 3 males, aged: 19.48 +/- 2.8 years suffering from postprandial epigastric pain, distention, nausea and vomiting. Diagnosis of SMAS was made by barium meal with single and double contrast study under the screen to show the vascular compression of the third part of duodenum and by ultrasonography to measure the aortomesenteric space in comparison with 10 healthy controls. Patients with SMAS had typically narrow aortomesentric space compared with controls [2.5 +/- 0.29 Vs 15.8 +/- 3.22 mm, P 0.001]. Nineteen [90.5%] patients had associated endoscopic acid peptic disease [6 had duodenal ulcer with antral gastritis and 13 had duodenitis with or without antral gastritis. Only 2 patients [9.5%] had normal endoscopy. Eighteen patients [85.7%] had positive [+ve] CLO for HP; 6 had +ve both antral and duodenal biopsies and 12 had only +ve duodenal biopsy. Only 3 patients were negative [-ve] for HP. Of the 19 patients having endoscopic acid peptic disease, 18 showed +ve CLO, only one had a-ve test. The 2 endoscopically normal patients showed -ve CLO. We conclude that HP could be a reason for the associated acid peptic disease with SMAS. There is a rationale for anti-HP therapy in the management plan of dyspeptic patients with SMAS

Mediastinite fibrosante por histoplasmose / Fibrous mediastinitis due to histoplasmosis

É apresentado o caso de um adulto jovem com síndrome de compressäo da veia cava superior, cuja etiologia foi atribuída ao Histoplasma capsulatum, através dos dados epidemiológicos sugestivos aliados às provas imunológicas. Após uma breve revisäo da literatura, säo feitas consideraçöes pertinentes às alteraçöes clínicas e patogênicas, aos achados de patologia e elementos de terapêutica