A 19-year-old male with a history of Soto´s Syndrome, bedridden for many years and cachectic was admitted to the ER for abdominal pain and vomits, compatible with an upper GI obstruction. A CT showed a distended stomach and the upper GI series demonstrated an extrinsic compression at the third duodenal portion (D3) (Figure 1), later confirm with a CT angiography.

Superior mesenteric artery (Wilkie's syndrome, an unusual cause of upper intestinal obstruction, is characterized by an extrinsic compression of the duodenum in its third portion between the superior mesentery artery (SMA) and the aorta, resulting in a functional obstruction. It is due to a narrowing of the aorta-SMA angle of <25°, causing a decrease in the distance between both vascular structures as little as 8-2mm [1]. This syndrome has usually been described after corrective spinal surgery and in those with a severe wight loss. The clinical picture is commonly characterized by symptoms of upper GI obstruction, abdominal pain, anorexia and weight loss. The diagnosis is confirmed with a CT angiogram (Figure 2) [2]. Treatment can range from conservative to surgical. Surgery consists on the mobilization of the duodenum by dividing the ligament of Treitz (Strong's procedure) or a duodenojejunostomy, the latter being the procedure of choice in adult patients, with a success rate near 100% [3].