DOI: https://doi.org/10.36347/sasjs.2026.v12i11.002

Pages: 906-909

Introduction: Superior mesenteric artery (SMA) syndrome, or Wilkie syndrome, is a rare cause of upper digestive obstruction due to compression of the third portion of the duodenum between the aorta and the SMA. Acute gastric dilatation complicated by gastric necrosis and perforation is an exceptional and life-threatening complication. Case presentation: We report the case of a 36-year-old woman with no medical history and a very thin body habitus, who presented to the emergency department with a three-day history of profuse, incoercible bilious vomiting, with cessation of stool but preserved passage of gas. Examination revealed abdominal distension with tympany. Laboratory tests showed hypokalemia and functional (prerenal) renal failure. After resuscitation and correction of the biological disorders, the plain abdominal radiograph showed a massively distended stomach, and computed tomography confirmed a voluminous gastric distension with a transition point at the duodenum, consistent with SMA syndrome. At laparotomy, the hugely distended stomach showed areas of necrosis with a perforation on its anterior wall. The necrotic area was resected and an omega-loop gastrojejunostomy was performed. The patient stayed four days in the intensive care unit and was discharged on postoperative day 8. Conclusion: SMA syndrome should be considered in thin young patients with acute high digestive obstruction. Massive gastric dilatation may lead to gastric necrosis and perforation; early diagnosis, gastric decompression and timely surgery are essential.