Wilkie's syndrome causing persistent vomiting post-colectomy.

Introduction: Wilkie's syndrome occurs when the superior mesenteric artery (SMA) compresses the third part of the duodenum causing proximal dilatation of small bowel. It is due to loss of the fat pad that sits between the duodenum and SMA and therefore is most commonly seen in people who have had significant weight loss.

Presentation Of Case: A 79 year old man presented with anaemia and weight loss and an ascending colon malignancy was found. He was built up nutritionally and subsequently underwent a right hemicolectomy. Post operatively he had persistent nausea and vomiting and duodenal compression by the SMA was identified on CT imaging. He was managed initially with parenteral nutrition then gradually enteral feeding was introduced via a nasojejunal tube. Symptoms resolved with weight gain and he was discharged well.

Discussion: This condition often presents insidiously with intermittent nausea and vomiting. It infrequently occurs with a more acute onset in surgical patients. It has a classic appearance on CT imaging and is usually managed with conservative treatment although surgical options are feasible if this fails.

Conclusion: Wilkie's syndrome is an interesting and infrequent cause of small bowel obstruction following colorectal surgery. A high index of suspicion is required.