Laparoscopic repositioning of the third and fourth portions of the duodenum in Wilkie’s syndrome: a case report

Wilkie’s syndrome, or superior mesenteric artery syndrome (SMAS), is a rare vascular compression disorder caused by reduction of the aortomesenteric angle and distance, leading to obstruction of the third portion of the duodenum. We report a 35-year-old female with an eight-year history of postprandial abdominal pain and nine months of vomiting associated with 18-kg weight loss. Magnetic resonance imaging demonstrated an aortomesenteric angle of 33° and distance of 10 mm, with morphologic compression of the third portion of the duodenum. Following failure of conservative management and a body mass index of 17 kg/m², laparoscopic repositioning of the third and fourth portions of the duodenum was performed. Approximately 5 cm of aortomesenteric decompression was achieved. The postoperative course was uneventful with discharge on postoperative day two. At one month, symptoms resolved with 4-kg weight gain. At five-year follow-up, the patient remains asymptomatic with stable normal body mass index (BMI). Minimally invasive anatomical decompression represents a durable and physiologic alternative to bypass procedures.