Abstract
Wilkie's syndrome, cast syndrome, or superior mesenteric artery syndrome, is a rare cause of upper intestinal obstruction due to compression of the third portion of the duodenum between the superior mesenteric artery and the abdominal aorta. It is frequently associated with significant weight loss, causing depletion of retroperitoneal fat, and narrowing of the aortomesenteric angle and distance. We report the case of a 45-year-old male with type 2 diabetes mellitus who developed progressive gastrointestinal symptoms over four months, including early satiety, postprandial abdominal pain, vomiting of gastric and biliary contents , and severe weight loss. On evaluation, body mass index was 15 kg/m². The patient appeared cachectic, with a distended abdomen, decreased bowel sounds, and tenderness in the epigastric region. Contrast-enhanced computed tomography revealed marked gastric dilation and duodenal distension, an aortomesenteric distance of 4.71 mm, and an aortomesenteric angle of 10.95°, confirming the diagnosis. Conservative management included electrolyte correction, nasogastric decompression, intravenous fluids, a hypercaloric diet, and postural changes. This case underscores the need for clinical suspicion and prompt imaging studies to avoid complications.