Skip to main content
Log in

Wilkie’s syndrome

  • Case Report
  • Published:
Journal of Ultrasound Aims and scope Submit manuscript


Superior mesenteric artery syndrome, also known as Wilkie’s syndrome, is a rare vascular disease caused by the anomalous course of the superior mesenteric artery arising from the abdominal aorta with a smaller angle than the norm (<22°). The reduced angle compresses the structures situated between the aorta and the superior mesenteric artery, such as the duodenum and left renal vein; this can determine painful crises, intestinal subocclusions, and left varicocele. This syndrome can be congenital or acquired. The acquired type is more common and is generally caused by reduced perivascular fat surrounding the abdominal aorta and the superior mesenteric artery; this form is common among anorexic patients that have had a rapid weight loss. We present the case of a female patient who suffered from repeated postprandial vomiting and who lost 12 kg in 4 months. B-mode ultrasound imaging revealed evidence of a reduced angle between the aorta and the superior mesenteric artery, as found in Wilkie’s syndrome. After diagnosis, the patient followed a high-calorie diet, and 2 months later an ultrasound scan proved the restoration of the aorto–mesenteric angle as a consequence of increased perivascular fat with regression of symptoms.


La sindrome dell’arteria mesenterica superiore o sindrome di Wilkie è una patologia vascolare rara dovuta all’anomalo decorso dell’arteria mesenterica superiore che nasce dall’aorta addominale con un angolo ridotto rispetto alla norma (inferiore a 22°). L’angolazione ridotta provoca la compressione delle strutture che passano tra l’aorta e l’arteria mesenterica superiore, il duodeno e la vena renale sinistra; questo può determinare crisi dolorose, sub-occlusioni intestinali e varicocele sinistro. Questa sindrome può essere congenita o acquisita. La forma acquisita, più frequente, è dovuta in genere alla riduzione del pannicolo adiposo peri-vascolare che circonda l’aorta addominale e l’arteria mesenterica superiore; questa forma è comune soprattutto nei pazienti anoressici che hanno subito una rapida perdita di peso. Presentiamo un caso di una paziente affetta da crisi ripetute di vomito post-prandiale che ha subito una perdita di 12 kg in 4 mesi. Durante l’esame ecografico B-Mode si evidenziava una riduzione dell’angolo tra aorta ed arteria mesenterica superiore, tipico della sindrome di Wilkie. Successivamente la paziente ha eseguito una dieta ipercalorica e dopo due mesi l’ecografia dimostrava il ripristino dell’angolo aorto-mesenterico come conseguenza dell’aumento del grasso peri-vascolare con regressione dei sintomi.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. Wilkie DPD (1927) Chronic duodenal ileus. Am J Med Sci 173:643

    Article  Google Scholar 

  2. Kwan E (2004) Wilkie’s syndrome. Surgery 135(2):225–227

    Article  PubMed  Google Scholar 

  3. Gthrie RH Jr (1971) Wilkie’s syndrome. Ann Surg 173(2):290–293

    Article  PubMed Central  Google Scholar 

  4. Fong JK, Poh AC, Tan AG et al (2014) Imaging findings and clinical features of abdominal vascular compression syndromes. Am J Roentgenol 203:29–36

    Article  Google Scholar 

  5. Gebhart T (2015) Superior mesenteric artery syndrome. Gastroenterol Nurs 38:189–193

    Article  PubMed  Google Scholar 

  6. Gulleroglu K, Gulleroglu B, Baskin Baskin (2014) Nutcracker syndrome. World J Nephrol 3:277–281

    Article  PubMed  PubMed Central  Google Scholar 

  7. Unal B, Aktas A, Kemal G et al (2005) Superior mesenteric artery syndrome; CT and ultrasonography findings. Diagn Interv Radiol 11(2):90–95

    PubMed  Google Scholar 

  8. Agrawal GA, Johnson PT, Fisherman EK (2007) Multidetector row CT of superior mesenteric artery syndrome. J Clin Gastroenterol 41(1):62–65

    Article  PubMed  Google Scholar 

  9. Welsch T, Büchler MW, Kienle P (2007) Recalling superior mesenteric artery syndrome. Dig Surg 24:149–156

    Article  PubMed  Google Scholar 

  10. Baltazar U, Dunn J, Floresguerra C et al (2000) Superior mesenteric artery syndrome: an uncommon cause of intestinal obstruction. South Med J 93(6):606–608

    Article  CAS  PubMed  Google Scholar 

  11. Inal M, Karadeniz Biligili MY, Sahin S (2014) Nutcracker syndrome accompanying pelvic congestion syndrome; color doppler sonography and multislice CT findings: a case report. Iran J Radiol 11:11075

    Google Scholar 

  12. Biank V, Werlin S (2006) Superior mesenteric artery syndrome in children: a 20-year experience. J Pediatr Gastroenterol Nutr 42(5):522–525

    Article  PubMed  Google Scholar 

  13. Ylinen P, Kinnunen J, Hockerstedt K (1989) Superior mesenteric artery syndrome. A follow-up study of 16 operated patients. J Clin Gastroenterol 11(4):386–391

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Renato Farina.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individuals participating in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Farina, R., Foti, P.V., Cocuzza, G. et al. Wilkie’s syndrome. J Ultrasound 20, 339–342 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: