Introduction:

Wilkie’s syndrome is a rare cause of duodenal obstruction due to compression of the third portion of the duodenum between the superior mesenteric artery and the aorta, often linked to malnutrition. It may mimic other conditions, such as duodenal tumors, complicating diagnosis.

Objective:

To describe a case of duodenal adenocarcinoma initially suspected to be Wilkie’s syndrome, highlighting the value of differential diagnosis.

Case report:

A 37-year-old male with chronic gastritis presented with severe anemia. He later reported bilious vomiting, malnutrition (BMI 16), and general deterioration. Imaging revealed gastric dilation, a duodenal mass, and a reduced aorto-mesenteric angle (14°), suggesting Wilkie’s syndrome. Exploratory laparotomy revealed a stenosing lesion in the third portion of the duodenum, contacting the pancreatic tail. Segmental duodenal resection and distal pancreatectomy were performed, followed by duodenojejunal anastomosis via transmesocolic approach. Pathology confirmed a moderately differentiated adenocarcinoma, stage IIB. Postoperative recovery was favorable.

Discussion:

The coexistence of Wilkie’s syndrome and duodenal adenocarcinoma is rare. Clinical overlap can delay diagnosis and influence treatment strategies. Appropriate imaging and multidisciplinary evaluation are essential for accurate management.

Conclusion:

In patients with obstructive symptoms and low BMI, organic causes such as duodenal tumors must be considered. Broad diagnostic thinking enables early detection and timely treatment.

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