Superior mesenteric artery syndrome


  • AKA: Wilke's syndrome
  • Rare condition, first described by Von Rokitansky in 1861 and then further studied in detail by Wilke in 1912
  • Occurs when duodenum is compressed between aorta and superior mesenteric artery
  • Can lead to gastrointestinal obstruction at level of duodenum
    • Chronic, intermittent, or acute
    • Partial or complete
  • Controversy over this diagnosis


Healthy SMA anatomy
  • SMA takes off from the abdominal aorta at about 45 degree angle, due to cushioning from fatty/lymphatic tissue called mesenteric pad
  • Third part of the duodenum courses between the angle formed
  • Narrowing of this angle can cause entrap and compress of the duodenum
  • Factors that narrow this angle include:
    • Significant weight loss (most common cause)
  • Corrective spinal surgery for scoliosis lengthens the spine
    • Congenital defects, suggested genetic predisposition
    • Abdominal adhesions

Clinical Features

Differential Diagnosis


  • Evaluate for alternative causes of symptoms and for complications
  • Suspected based on signs and symptoms
  • Diagnosis confirmed by imaging:
    • Upper GI series
    • Upper endoscopy
    • CT


  • Correct dehydration, electrolyte abnormalities, malnutrition
  • Primary goal is to correct the underlying cause, typically regain lost weight
  • Acute management:
    • Adjusting body position to alleviate symptoms, such as knee to chest or lying on left side
    • Nasogastric tube for decompression
  • Some patients may require a feeding tube distal to the obstruction or parenteral nutrition
  • Surgery sometimes indicated
    • Strong's procedure: duodenum moved to the right of the SMA
    • Gastrojejunostomy, duodenojejunostomy


  • Depends on clinical presentation
  • If complete obstruction, admission for decompression and nutrition
  • Outcome excellent with early diagnosis and appropriate treatment

See Also

External Links


  • 1. <Karrer FM. Superior Mesenteric Artery Syndrome. Medscape Reference. Jan 2017;>
  • 2. <Pleoa A, Constantinescu C, Crumpei F, and Cotea E. Superior mesenteric artery syndrome: an unusual cause of intestinal obstruction. "J Gastrointest Liver Dis". Mar 2006; 15(1): 69-72.>
  • 3. <Lorentziadis M. Wilke's syndrome. A rare cause of duodenal obstruction. "Ann Gastroenterol." 2011; 24(1): 59-61.