Wilke’s syndrome. A rare cause of duodenal obstruction
A 15-year-old female patient was urgently admitted with symptoms of dehydration, loss of appetite and persistent vomiting for 10 weeks. For four months she was vomiting two to three times weekly and this increased to three to four times daily during the last week before admission. The vomitus consisted of undigested meals eaten recently without any blood. During the last four months the patient reported a significant weight loss (21 kg). Her past medical history was free. On admission the patient was very thin and extremely weak with signs of severe dehydration. A nasophagogastric tube was inserted and the fluid and electrolyte balance was corrected by parenteric infusion of crystalloid fluids with electrolytes. Two days later the patient was subjected to gastroscopy which showed mild inflammation of the lower esophageal mucosa and gastritis. The instrument could not pass further than the third part of the duodenum, due to extraluminal pressure on the duodenal wall. Barium meal follow through confirmed the extrinsic obstruction of the third part of the duodenum and proximal dilation of the stomach and duodenum [] with normal motility of the upper GI tract. CT scan of the upper and lower abdomen excluded the possibility of a tumor or an annular pancreas being the cause of the compression of the duodenum. Thus based on the history, the clinical and imaging findings of the patient, the diagnosis of Wilke’s syndrome was concluded.\nThe patient denied the initially suggested conservative treatment and therefore she was subjected to laparotomy. The first and second parts of the duodenum were dilated and hypertrophied. The dilated duodenum was abrupted at the point where the superior mesenteric artery crossed the third part of the duodenum []. These findings confirmed the diagnosis and a site to site duodenojejunostomy in two layers was performed []. The postoperative course was uneventful and barium meal a month postoperatively showed unobstructed passage of the contents from the duodenum to the jejunum. One year later the patient gained the lost weight and remained asymptomatic.