History of Vomiting

Fifty-eight-year-old patient presented with history of vomiting.

Figure 1A. Scanogram shows distended stomach and proximal duodenum.

Figure 1B. Shows distended stomach, first and second part of duodenum.

Figure 2. Shows distended stomach, first and second part of duodenum.

Figure 3. Shows distended stomach, first and second part of duodenum.

Figure 4. Shows distended stomach, first and second part of duodenum.

Figure 5. Shows distended stomach, first and second part of duodenum. Also space between aorta and SMA is reduced as shown.

Figure 6. Shows distended stomach, first and second part of duodenum.

Figure 7. Shows distended proximal duodenum and obstruction in third part of duodenum.

Figure 8. Shows small angle of SMA with aorta.

CT scan showed stomach markedly over distended but oral contrast is seen to pass into small bowel.

Plain radiograph demonstrates a dilated, fluid- and gas-filled stomach.

Superior mesenteric artery (SMA) syndrome, also known as Wilkie syndrome, is a rare acquired vascular compression disorder in which acute angulation of superior mesenteric artery (SMA) results in compression of the third part of the duodenum leading to obstruction.

It is an uncommon but well recognized clinical entity.

Normally, fat and lymphatic tissues around the SMA provide protection to the duodenum against compression.

Surgery may be considered if conservative treatment fails.