Superior mesenteric artery syndrome in a patient with acute lymphoblastic leukemia. Case report ; Síndrome de la arteria mesentérica superior en una paciente con leucemia linfoblástica aguda. Reporte de caso

Introduction: Superior mesenteric artery syndrome, also known as Wilkie's syndrome, occurs due to a decrease in the aortomesenteric angle, resulting in compression of the third portion of the duodenum. In many cases, the symptomatology is nonspecific and its etiology is associated with a decrease in mesenteric fat. Diagnosis is based on imaging and endoscopic findings. Treatment is focused on correcting the cause related to weight loss and, in refractory cases, surgery is indicated. Case presentation: A 19-year-old female attended a tertiary care institution in the city of Bucaramanga (Colombia) after experiencing weight loss and a decrease in appetite for two months. Blood tests showed anemia and hyperleukocytosis with 37% blasts, resulting in a diagnosis of acute lymphoid leukemia diagnosed via bone marrow aspiration. During her hospital stay, she presented abdominal pain, vomiting, and intolerance to oral intake. A CAT scan of the abdomen showed distension of the third and fourth portions of the duodenum and a reduction of the aortomesenteric angle (18.8º), which generated a proximal mechanical obstruction of the bowel. Medical treatment, total parenteral nutrition and postprandial postural therapy were initiated. Follow-up digestive tract imaging showed adequate passage of contrast medium to the jejunum. The patient tolerated the initiation of the oral intake and had a good clinical progress. Conclusions: Superior mesenteric artery syndrome is a rare cause of intestinal obstruction with variable clinical features, so high diagnostic suspicion is required. Imaging studies should be performed to confirm the diagnosis and early medical treatment should be initiated to avoid possible surgical interventions. ; Resumen Introducción. El síndrome de la arteria mesentérica superior, también llamado síndrome de Wilkie, ocurre por la disminución del ángulo aortomesentérico con compresión de la tercera porción duodenal. La sintomatología en muchos casos es inespecífica y su etiología se presenta por causas ...