{"id":19399,"date":"2025-11-18T01:19:13","date_gmt":"2025-11-18T01:19:13","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/es\/?p=19399"},"modified":"2025-11-18T01:19:18","modified_gmt":"2025-11-18T01:19:18","slug":"sindrome-de-la-arteria-mesenterica-superior-como-causa-subestimada-de-erge-lo-que-el-endoscopista-necesita-saber","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/es\/temas-generales\/sindrome-de-la-arteria-mesenterica-superior-como-causa-subestimada-de-erge-lo-que-el-endoscopista-necesita-saber\/","title":{"rendered":"S\u00edndrome de la arteria mesent\u00e9rica superior como causa subestimada de ERGE: lo que el endoscopista necesita saber"},"content":{"rendered":"\n

El s\u00edndrome de la arteria mesent\u00e9rica superior, tambi\u00e9n conocido como s\u00edndrome de Wilkie, es una afecci\u00f3n poco frecuente y a menudo infradiagnosticada, caracterizada por la compresi\u00f3n del duodeno entre la arteria mesent\u00e9rica superior y la aorta (1,2). Descrito en 1842 por Carl von Rokitansky (1804-1878) a partir de hallazgos de autopsia (3,5), su fisiopatolog\u00eda implica una disminuci\u00f3n del \u00e1ngulo entre la aorta y la arteria mesent\u00e9rica superior, asociada a la tracci\u00f3n craneal del duodeno distal ejercida por el ligamento de Treitz (1).<\/p>\n\n\n\n

En 1908, Codman propuso que la obstrucci\u00f3n duodenal cr\u00f3nica resultante de esta compresi\u00f3n podr\u00eda explicar s\u00edntomas gastrointestinales inespec\u00edficos como la pirosis y el dolor epig\u00e1strico (6). En 1927, David Wilkie (1882-1938) describi\u00f3, en una serie de casos, aspectos fisiopatol\u00f3gicos que corroboraban la teor\u00eda de Codman, adem\u00e1s de proponer estrategias terap\u00e9uticas iniciales (2,4). Posteriormente, en 1948, Grauer utiliz\u00f3 por primera vez el t\u00e9rmino \u00abs\u00edndrome de Wilkie\u00bb, uno de los varios sin\u00f3nimos conocidos para esta afecci\u00f3n (5).<\/p>\n\n\n\n

La compresi\u00f3n duodenal por la arteria mesent\u00e9rica superior es infrecuente y dif\u00edcil de diagnosticar, con una incidencia estimada entre el 0,013 % y el 0,78 %, seg\u00fan estudios radiogr\u00e1ficos (7-12). Puede ser cong\u00e9nita o adquirida, siendo m\u00e1s com\u00fan en mujeres j\u00f3venes. Se asocia con p\u00e9rdida de peso r\u00e1pida, estados catab\u00f3licos (13-15) o se produce como resultado de cambios anat\u00f3micos postoperatorios e inmovilizaci\u00f3n prolongada (12,13,16). En la infancia, las causas m\u00e1s comunes incluyen la hipertrofia o el acortamiento cong\u00e9nito del ligamento de Treitz y la implantaci\u00f3n an\u00f3mala de la arteria mesent\u00e9rica superior (12,17).<\/p>\n\n\n\n

El pinzamiento aortomesent\u00e9rico puede manifestarse con s\u00edntomas inespec\u00edficos como dolor abdominal, n\u00e1useas, saciedad precoz y p\u00e9rdida de peso (18). Su asociaci\u00f3n con la enfermedad por reflujo gastroesof\u00e1gico (ERGE) y la \u00falcera p\u00e9ptica se ha descrito en la literatura (19,20). La ERGE, definida como el reflujo del contenido g\u00e1strico hacia el es\u00f3fago con potencial para causar s\u00edntomas y\/o complicaciones, puede agravarse por afecciones que retrasan el vaciamiento g\u00e1strico, como la obstrucci\u00f3n duodenal extr\u00ednseca observada en el s\u00edndrome de la arteria mesent\u00e9rica superior (21). En estos casos, la estasis alimentaria y el aumento de la presi\u00f3n intrag\u00e1strica favorecen el reflujo gastroesof\u00e1gico. Adem\u00e1s, la presencia de gastroptosis \u2014frecuente en personas delgadas y altas\u2014 puede coexistir, contribuyendo a su fisiopatolog\u00eda (19). Una serie de casos de 30 pacientes con s\u00edntomas de reflujo gastroesof\u00e1gico demostr\u00f3 una predominancia de mujeres y un bajo \u00edndice de masa corporal, con una alta frecuencia de gastroptosis concomitante (19). Los autores sugieren que el pinzamiento aortomesent\u00e9rico induce espec\u00edficamente reflujo biliar alcalino, neutralizando el contenido \u00e1cido g\u00e1strico y contribuyendo a un cuadro de ERGE con pH elevado. La coexistencia de reflujo g\u00e1strico y duodenal parece asociarse con peores resultados cl\u00ednicos, con una mayor tasa de complicaciones en comparaci\u00f3n con el reflujo \u00e1cido aislado (22-24).<\/p>\n\n\n\n

El tratamiento inicial en casos leves o moderados es conservador, con medidas conductuales como modificaciones diet\u00e9ticas y posturales despu\u00e9s de las comidas. En casos con s\u00edntomas de ERGE, se puede instaurar terapia con inhibidores de la bomba de protones (19-25). El tratamiento quir\u00fargico se reserva para pacientes refractarios al tratamiento cl\u00ednico.<\/p>\n\n\n\n

El diagn\u00f3stico se realiza preferiblemente mediante tomograf\u00eda computarizada, con hallazgos caracter\u00edsticos como un \u00e1ngulo aortomesent\u00e9rico menor de 22\u00b0 y una distancia entre vasos menor de 8 mm (25). La endoscopia digestiva alta puede ser \u00fatil en las etapas iniciales, aunque por s\u00ed sola no es concluyente. Kim et al. (26) describieron tres hallazgos endosc\u00f3picos indirectos sugestivos de pinzamiento aortomesent\u00e9rico: <\/p>\n\n\n\n

    \n
  1. Compresi\u00f3n puls\u00e1til vertical u oblicua en la tercera porci\u00f3n del duodeno con una expansi\u00f3n luminal inferior al 30 % incluso tras una insuflaci\u00f3n continua durante 15 segundos<\/li>\n\n\n\n
  2. Dilataci\u00f3n del duodeno proximal<\/li>\n\n\n\n
  3. Presencia de secreci\u00f3n biliar en la cavidad g\u00e1strica<\/li>\n<\/ol>\n\n\n\n

    Otras pruebas complementarias incluyen la ecograf\u00eda Doppler para evaluar el espacio aortomesent\u00e9rico y la gammagraf\u00eda de vaciamiento g\u00e1strico (25). Dada su fisiopatolog\u00eda singular y su presentaci\u00f3n cl\u00ednica inespec\u00edfica, el s\u00edndrome de pinzamiento aortomesent\u00e9rico (SAMS) debe considerarse en el diagn\u00f3stico diferencial de la ERGE, especialmente en pacientes j\u00f3venes y delgados o con antecedentes de p\u00e9rdida de peso significativa. La sospecha cl\u00ednica por parte del endoscopista puede ser crucial para un diagn\u00f3stico precoz y una derivaci\u00f3n adecuada. Reconocer los signos endosc\u00f3picos indirectos, contextualizados con los hallazgos cl\u00ednicos y radiol\u00f3gicos, es esencial para evitar retrasos terap\u00e9uticos en una afecci\u00f3n potencialmente reversible.<\/p>\n\n\n\n


    Referencias<\/strong><\/h2>\n\n\n\n
      \n
    1. Ali T, Tomka J, Bakirli I, Bakirov I. Surgical treatment of Wilkie’s syndrome by vascular transposition. Cureus. 2022;14(4):e24251.<\/li>\n\n\n\n
    2. Yale SH, Tekiner H, Yale ES. Historical terminology and superior mesenteric artery syndrome. Int J Surg Case Rep. 2020;67:282\u20133.<\/li>\n\n\n\n
    3. Rokitansky C. Manual de anatomia patol\u00f3gica. Vol. 3. Viena: Braum\u00fcller & Seidel; 1842. p. 215\u20139.<\/li>\n\n\n\n
    4. Wilkie DPD. Chronic duodenal ileus. Am J Med Sci. 1927;173:643\u20139.<\/li>\n\n\n\n
    5. Grauer FW. Duodenal ileus (Wilkie’s syndrome) arterio-mesenteric ileus. Bull Vancouver Med Assoc. 1948;24(4):116\u20138.<\/li>\n\n\n\n
    6. Codman EA. Chronic obstruction of the duodenum at the root of the mesentery. Boston Med Surg J. 1908;158:503\u201310.<\/li>\n\n\n\n
    7. Ylinen P, Kinnunen J, H\u00f6ckerstedt K. Superior mesenteric artery syndrome: A follow-up study of 16 operated patients. J Clin Gastroenterol. 1989;11(4):386\u201391.<\/li>\n\n\n\n
    8. Yamamoto T, Okada K, Kasugai M, Kato M, Kan S. Laboratory and clinical studies on cefatrizine. Jpn J Antibiot. 1977;30:763\u20139.<\/li>\n\n\n\n
    9. Anderson JR, Earnshaw PM, Fraser GM. Extrinsic compression of the third part of the duodenum. Clin Radiol. 1982;33:75\u201381.<\/li>\n\n\n\n
    10. Rosa-Jim\u00e9nez F, Rodr\u00edguez Gonz\u00e1lez FJ, Puente Guti\u00e9rrez JJ, Mu\u00f1oz S\u00e1nchez R, Adarraga Cansino MD, Zambrana Garc\u00eda JL. Duodenal compression caused by superior mesenteric artery: Study of 10 patients. Rev Esp Enferm Dig. 2003;95:485\u20139.<\/li>\n\n\n\n
    11. Goin LS, Wilk SP. Intermittent arteriomesenteric occlusion of the duodenum. Radiology. 1956;67:729\u201337.<\/li>\n\n\n\n
    12. Oka A, Awoniyi M, Hasegawa N, Yoshida Y, Tobita H, Ishimura N, et al. Superior mesenteric artery syndrome: Diagnosis and management. World J Clin Cases. 2023;11(15):3369\u201384.<\/li>\n\n\n\n
    13. Welsch T, B\u00fcchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg. 2007;24(3):149\u201356.<\/li>\n\n\n\n
    14. Lee TH, Lee JS, Jo Y, Park KS, Cheon JH, Kim YS, et al. Superior mesenteric artery syndrome: Where do we stand today? J Gastrointest Surg. 2012;16(12):2203\u201311.<\/li>\n\n\n\n
    15. Ganss A, Rampado S, Reul M, Schreyer AG, Schlag C, G\u00f6lder S. Superior mesenteric artery syndrome: A prospective study in a single institution. J Gastrointest Surg. 2019;23(5):997\u20131005.<\/li>\n\n\n\n
    16. Berk RN, Coulson DB. The body cast syndrome. Radiology. 1970;94:303\u20135.<\/li>\n\n\n\n
    17. Trestrail T, Martin EK, Bhutiani N, Mortensen GF, Davidyuk V, Vitale GC. An unusual presentation of congenital superior mesenteric artery syndrome. J Surg Case Rep. 2019;2019(3):rjz067.<\/li>\n\n\n\n
    18. Forte A, Santarpia L, Venetucci P, Barbato A. Aorto-mesenteric compass syndrome (Wilkie’s syndrome) in the differential diagnosis of chronic abdominal pain. BMJ Case Rep. 2023;16(9):e254157.<\/li>\n\n\n\n
    19. Zhang R, Li ZT, Han XW, Liang LD, Wang ZG, Ji F. Diagnosis and treatment of superior mesenteric artery compression syndrome complicated with gastroesophageal reflux disease. Chin Med J (Engl). 2021;134(11):1382\u20134.<\/li>\n\n\n\n
    20. Thompson NW. Vascular compression of the duodenum and peptic ulcer disease. Arch Surg. 1974;108(5):674.<\/li>\n\n\n\n
    21. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27\u201356.<\/li>\n\n\n\n
    22. Stein HJ, Barlow AP, DeMeester TR, Hinder RA. Complications of gastroesophageal reflux disease. Ann Surg. 1992;216(1):35\u201343.<\/li>\n\n\n\n
    23. Boeckxstaens GE, Smout A. Role of acid, weakly acidic and weakly alkaline reflux in gastro-oesophageal reflux disease: A systematic review. Aliment Pharmacol Ther. 2010;32(3):334\u201343.<\/li>\n\n\n\n
    24. Pellegrini CA, DeMeester TR, Wernly JA, Johnson LF, Skinner DB. Alkaline gastroesophageal reflux. Am J Surg. 1978;135(2):184\u201390.<\/li>\n\n\n\n
    25. Oka A, Awoniyi M, Hasegawa N, Yoshida Y, Tobita H, Ishimura N, et al. Superior mesenteric artery syndrome: Diagnosis and management. World J Clin Cases. 2023;11(15):3369\u201384.<\/li>\n\n\n\n
    26. Kim H, Kim M, Yoon H, Shin CM, Park YS, Kim N, et al. Endoscopic findings suggestive of superior mesenteric artery syndrome. Clin Endosc. 2021;54(1):140\u20134.<\/li>\n<\/ol>\n\n\n\n

      C\u00f3mo citar este art\u00edculo<\/h2>\n\n\n\n

      Zwetkoff BHF, Campos JB, Penaloza CSQ. S\u00edndrome de la arteria mesent\u00e9rica superior como causa subestimada de ERGE: lo que el endoscopista necesita saber. Endoscopia Terap\u00e9utica 2025, Vol II. Disponible en: https:\/\/endoscopiaterapeutica.net\/es\/temas-generales\/sindrome-de-la-arteria-mesenterica-superior-como-causa-subestimada-de-erge-lo-que-el-endoscopista-necesita-saber\/<\/a><\/p>\n\n\n\n

      <\/p>\n","protected":false},"excerpt":{"rendered":"

      El s\u00edndrome de la arteria mesent\u00e9rica superior, tambi\u00e9n conocido como s\u00edndrome de Wilkie, es…<\/p>\n","protected":false},"author":6148,"featured_media":19389,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[750],"tipo":[153],"volume":[147],"class_list":["post-19399","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-temas-generales","ano-750","tipo-endoscopia-digestiva-superior","volume-volumen-ii"],"yoast_head":"\nS\u00edndrome de la arteria mesent\u00e9rica superior como causa subestimada de ERGE: lo que el endoscopista necesita saber • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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