The Etiopathogenetic Features of Wilkie’s Syndrome in the Context of Individual Anatomical and Anthropometric Predispositions: A Case Report

Rationale. Research on Superior Mesenteric Artery Syndrome (SMAS, or Wilkie’s Syndrome) is a crucial step towards a deeper understanding of its etiopathogenetic mechanisms. The analysis of anatomical and anthropometric characteristics in patients with this syndrome can significantly contribute to the development of predictive models. These models would allow for the forecasting of SMAS development based on baseline constitutional and morphometric parameters. This is particularly significant when planning body mass correction programs, including dietary approaches and bariatric surgery. Objective: To analyze the relationship between metabolic and anatomical-anthropometric factors influencing the development of Wilkie’s syndrome, based on clinical case data. Materials and Methods. We present a case of Wilkie’s syndrome in a 20-year-old female patient (P.), which developed following intentional weight loss due to obesity, approximately 3.5 months after initiating a low-calorie diet. The key relevant patient characteristics, obtained through physical examination, laboratory tests, and imaging studies, are described in detail in chronological order. These include both general parameters (BMI, somatotype) and specific morphometric measurements of the aortomesenteric space and abdominal organ anatomy following weight loss. The article also includes a brief review of the scientific literature focused on the influence of anatomical and anthropometric predispositions on the development of Wilkie’s syndrome. Results. The data obtained from the investigation point to key factors that contributed to the development of Wilkie’s syndrome in our patient. Two primary mechanisms can be identified. The first mechanism is related to pronounced and rapid systemic weight loss, resulting in a body mass deficit (BMI 18.0 kg/m²). This catabolic loss of the retroperitoneal fat layer - specifically from the anterior pararenal and the unpaired median spaces - led to a critical narrowing of the aortomesenteric space. This was evidenced by a reduction of the aortomesenteric angle (AMA) and aortomesenteric distance (AMD) to 6° and 3 mm, respectively. This narrowing caused compression of the third part of the duodenum passing through this space, resulting in its obstruction. Furthermore, the patient’s asthenic somatotype suggests a pre-existing, more acute origin angle of the Superior Mesenteric Artery (SMA). The second mechanism involves gastropotosis and gastrectasis, which developed due to a catabolic weakening of the gastric ligaments and subsequent food retention. In our view, this led to compression against the posterior abdominal wall and the underlying retroperitoneal structures, thereby exacerbating the aortomesenteric compression of the duodenum. Additionally, the patient was found to have grade II thoracolumbar scoliosis, which may represent an additional risk factor for Wilkie’s syndrome. Both scoliosis and visceroptosis can develop against a background of muscular-ligamentous laxity, which has its basis in connective tissue dysplasia. Conclusion. This clinical case is of interest due to the rarity and multifactorial nature of the disease. In patients with significant weight loss related to malnutrition or other wasting conditions who are hospitalized with a suspected “acute abdomen,” Wilkie’s syndrome should be considered as a differential diagnosis. During the initial workup, standard laboratory and instrumental methods - such as endoscopy, ultrasonography, and contrast radiography - can be useful but lack sufficient sensitivity and specificity. Furthermore, upon admission, key biochemical parameters, red blood cell indices, and the leukocyte formula may remain within reference ranges or show only minor deviations. Computed tomography angiography with 3D reconstruction is the most informative diagnostic method. This technique not only allows for the direct visualization of duodenal compression between the aorta and the superior mesenteric artery but also enables a detailed analysis of the underlying anatomical and anthropometric features contributing to its development.

Superior Mesenteric Artery Syndrome, Wilkie’s Syndrome, Aortomesenteric Compression, Duodenal Obstruction, CT Angiography, Gastropotosis

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