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Image of the Month—Diagnosis
Arch Surg. 2006;141:608.
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Answer: Superior Mesenteric Artery Syndrome
Superior mesenteric artery syndrome is an unusual cause of bowel obstruction that results from extrinsic duodenal compression as it passes between the superior mesenteric artery and aorta. Synonymous with the phrases Wilkie syndrome, Cast syndrome, arteriomesenteric duodenal compression, and chronic duodenal ileus, this disease process is typically precipitated by factors that create a narrowing of the angle between the 2 vascular structures.1 Predisposing factors include weight loss, lordosis, presence of an abdominal aortic aneurysm, an abnormally high fixation of the ligament of Treitz, or extensive loss of retroperitoneal and mesenteric fat.2-3 This syndrome is seen in patients with wasting disorders, severe head injuries, or spinal deformities.3 First described by Karl von Rokitansky in 1861, vascular compression of the duodenum has been noted in 0.013% to 0.13% of all upper gastrointestinal tract barium series performed.4
Patients with this disease process typically have chronic, intermittent abdominal pain that is associated with nausea, . . . [Full Text of this Article]
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Image of the Month—Quiz Case
Jonathan D. McCue, Dilip S. Nath, and Bruce A. Bennett
Arch Surg. 2006;141(6):607.
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