CHRONIC DUODENAL ILEUS (WILKIE’S SYNDROME)

It is also called as superior mesenteric artery (SMA) syndrome. It is due to obstruction of the 3rd part of the duodenum due to decreased angle between SMA and aorta.

 There will be narrowing of aortomesenteric angle, becoming less than 15.2°; aortomesenteric distance becoming less than ,10 mm with abnormally low origin of SMA.

It can be congenital or due to low insertion of SMA or high insertion of duodenal end or due to traumatic aneurysm of SMA.It can be aggravated by plaster casts, lordosis, pancreatic tumour, enlarged lymph node in the 3rd part of duodenum (Cast syndrome).

FEATURES

• Bilious vomiting.
• Upper abdominal fullness.
• Visible peristalsis.
• Dehydration

INVESTIGATION

• Barium meal is diagnostic.
• CT scan abdomen.

TREATMENT

• Duodenojejunostomy with division of the ligament of
• Treitz is the most common and most successful procedure done.
• Strong’s operation –division of ligament of Treitz and transposition of the SMA.
• Anterior transposition of the 3rd part of the duodenum.