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Superior mesenteric artery (SMA) syndrome is a rare condition caused by compression of the third portion of duodenum by the angle between the superior mesenteric artery against the aorta. A rare presentation of SMA syndrome is following scoliosis repair and spinal fusion with a low incidence and most of these patients present with symptoms within one to two weeks or even more after the surgical repair. A high suspicion index after surgical correction of scoliosis with well-known risk factors (low BMI, low percentile of weight for height, and a high degree of change in the Cobb's angles) can anticipate the postoperative diagnosis. Management has been described for postsurgical scoliosis repair with a late onset presentation of SMA syndrome with nutritional support with good success rates, but there is no data for best treatment management for acute onset especially when the surgical correction of the spine causes complete duodenal obstruction and a surgical intervention might be warranted. Here in, we present a 14 year-old boy with an acute 24-h postoperative SMA syndrome following surgical correction of scoliosis. © 2017 The Authors

ResumenAntecedentesEl síndrome de Wilkie o síndrome de la arteria mesentérica superior es una causa inusual de oclusión intestinal alta, se caracteriza por la compresión del duodeno en su tercera porción, es secundaria a un estrechamiento del espacio entre la arteria mesentérica superior y la aorta. El cuadro clínico suele estar caracterizado por síntomas de oclusión intestinal alta, la exploración física y los hallazgos de laboratorio suelen ser poco específicos. Diversos estudios de imagen son útiles para el diagnóstico. El tratamiento puede ir desde conservador, hasta la cirugía, que depende de cada caso.Caso clínicoVarón de 19 años, que cursó con dolor abdominal súbito, intenso, náuseas, vómitos y diarrea; motivo por el cual acudió al servicio de urgencias, donde a la exploración destacaron: rigidez abdominal con hiperestesia e hiperbaralgesia, y los estudios de imagen evidenciaron una disminución del ángulo de la arteria mesentérica superior y de la distancia aortomesentérica; además de disminución del calibre de la tercera porción del duodeno, hallazgos característicos del síndrome de Wilkie. Se dio tratamiento conservador, siendo dado de alta hospitalaria sin complicaciones.ConclusionesEl síndrome de Wilkie continúa siendo una entidad poco conocida por el médico general, el que poco se diagnostique o se piense en este síndrome, puede ocasionar complicaciones serias por lo que se requiere que el médico guarde un alto índice de sospecha diagnóstica ante esta patología. El tratamiento oportuno confiere un buen pronóstico la mayoría de las veces.AbstractBackgroundWilkie syndrome, also referred as superior mesenteric artery syndrome, is an unusual cause of a proximal small bowel obstruction. It is characterised by the compression of the duodenum in its third portion due to a narrowing of the space between the superior mesenteric artery and the aorta. Its presentation symptoms are consistent and include the obstruction of the proximal small bowel. However, the physical and laboratory findings are non-specific. Nevertheless, many imaging methods are useful for its diagnosis. The management of this condition varies between observation and surgery, depending on each particular case.Clinical caseThe case is presented of a 19 year-old male who began with acute, intense abdominal pain, nausea, vomiting, and diarrhoea. On examination, he had abdominal wall rigidity and hyperesthesia. Imaging studies were requested, revealing a decreased superior mesenteric artery angle, a shortening of the aortic mesenteric distance, and a decrease in the calibre of the third duodenal portion, all findings concomitant with Wilkie syndrome. Conservative treatment was applied and the patient was discharged without complications.ConclusionsWilkie syndrome continues to be an unknown condition to the general practitioner, and the underdiagnosis of this condition may put a patient at risk of serious complications. A high index of suspicion is required to reach a diagnosis. Early treatment should give a good outcome most of the time.

1. 1. Five cases of acute obstruction of the duodenum occurring in the newborn are presented. 2. 2. A discussion of the various anatomic abnormalities encountered, symptomatology, roentgenograph diagnosis and methods of treatment are presented.

We report a case of a ten-year-old child presenting with a three-year history of recurrent abdominal pain. The patient was found to have a high grade obstruction of the third portion of the duodenum secondary to congenital bands. The diagnosis was made radiographically and surgery was curative.