A 24-year-old markedly thin woman reports postprandial epigastric pain and bilious projectile vomiting, relieved by lying prone. Barium meal shows abrupt vertical cut-off of the third part of the duodenum with delayed passage of contrast across the midline. What is the underlying anatomical abnormality?

• A Malrotation with Ladd bands over the duodenojejunal flexure
• B Annular pancreas encircling the second part of the duodenum
• C Duodenal web causing incomplete obstruction
• D Compression of the duodenum between the aorta and the superior mesenteric artery ✓

Explanation

This is superior mesenteric artery (SMA) syndrome, also called Wilkie syndrome. Loss of the fat pad in the aortomesenteric angle, seen in rapid weight loss, scoliosis surgery, or prolonged bed rest, narrows the angle and compresses the third part of the duodenum against the aorta. Relief in the prone or knee-elbow position supports the diagnosis. Annular pancreas obstructs the second part and does not characteristically improve with posture.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.