A 31-year-old woman was admitted to the Internal Medicine Department of our hospital in 2008 due to unquantified weight loss and vomiting of unknown duration.
The patient did not report any other symptoms by equipment.
During admission a complete biochemical study, blood count and thyroid function were normal.
Infectious diseases were ruled out, with various serologies being performed, determination of fecal incontinence, etc., resulting in all negative studies.
The presence of digestive pathology was also ruled out, and specifically malaorptive manifestations (high digestive endoscopy), antigliadin and antiendomysial antibodies, duodenal biopsy: normal).
The gastroesophagoduodenal study showed dilation of the second portion of the duodenum in relation to the understanding, suggestive of pinza stenosis of the diagnostic arteries confirmed by CT angiography
The patient was also assessed by Psychiatry, ruling out the presence of eating behavior disorder.
1.
With the diagnosis of Wilkie's syndrome, she was referred to the Nutrition Service in November 2009.
She reported a normal weight of 56 kg. At that time she weighed 43.9 kg and her body mass index (BMI) was 16.7 kg/m2.
Initially nutritional management was attempted with dietary modifications, postural measures and prescription of supplements, without improvement; although at no time of evolution the patient had retention stomach or electrolyte disturbances.
In January 2010, with 42.6 kg, it was proposed the placement of a feeding tube on a provisional basis to try nutritional recovery through the administration of enteral nutrition (EN).
Digestive tolerance was good and did not present Realization Syndrome, increasing its weight to 50 kg (BMI: 19).
At that time, attempts were made to reintroduce natural foods, reappearing vomiting, so a new gastroduodenal study was performed, with findings similar to the diagnosis.
This situation, according to the patient, is consulted with the General Surgery Service and surgical treatment is proposed.
A duodenojejunostomy is performed.
Oral tolerance after surgery was initially problematic in relation to gastric hypotonia, requiring treatment with prokinetics.
Two months after the surgery the patient was completely asymptomatic, weighing 50 kg, oral tolerance was good and the barium swallow study showed a normal stomach with duodenum morphology and consolidation and good contrast passage.
Now the patient has lost weight kg again.
He denies the existence of digestive symptoms, and says he is thin and wants to regain the weight lost; but he rejects taking nutritional supplements, as well as performing any medical study and re-evaluation by the Department of Psychiatry.
