A rare instance of Wilkie’s syndrome in a young male during the holy month of Ramadan

INTRODUCTION AND IMPORTANCE: Wilkie’s syndrome[SMA(Superior Mesenteric Artery) syndrome or Cast syndrome]) is a unique and rare presentation which may be included in the differential diagnosis especially when a Gastric outlet obstruction is being investigated and there is a history of an associated element of rapid weight loss. The purpose of presenting this case report is its uniqueness given a history of intermittent fasting rather than the usual eating disorders. CASE PRESENTATION: A crescendo worsening of symptoms of intractable vomiting, inability to eat, upper abdominal gas bloating and post meal abdominal pain since one week in a patient during a period of fasting for the first time had been observed. CLINICAL DISCUSSION: After initial resuscitation, an ultrasound abdomen and an abdominal x ray revealed a distended stomach and a nasogastric tube was immediately introduced to avoid aspiration. A CT scan of the abdomen with contrast revealed the compressed duodenum in the aortomesenteric angle and the diagnosis of SMA syndrome was confirmed. An upper gastrointestinal endoscopy was also done to rule out other causes and it was found to be normal. CONCLUSION: In an acute presentation, the response to conservative management is remarkable and in the absence of any possible future reoccurrences the surgical options may be avoided. High index of suspicion, appropriate radiological diagnosis and stepwise treatment options may guide the troubled patient towards recovery in this rare presentation. A proper history taking is key in diagnosing such a condition and does not have to be limited to eating disorders, typically.