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Case Reports
. 2019 Jan 23;19(1):15.
doi: 10.1186/s12876-019-0932-1.

Superior mesenteric artery syndrome coexists with Nutcracker syndrome in a female: a case report

Ying Shi  1   2 , Guangya Shi  3 , Zhenyu Li  4 , Yanfang Chen  5   6 , Shaohui Tang  5   6 , Wei Huang  7   8
Affiliations
Case Reports

Superior mesenteric artery syndrome coexists with Nutcracker syndrome in a female: a case report

Ying Shi et al. BMC Gastroenterol. .

Abstract

Background: Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome or Benign duodenal stasis, is a rare benign disease. It could threaten the life if the manifestation is severe and the treatment is inappropriate. In the patients with SMA syndrome, the third portion (transverse part) of the duodenum is compressed externally between the SMA and abdominal aorta (AA) leading to duodenal stasis and gastrointestinal obstruction. SMA syndrome may rarely combine with Nutcracker syndrome when left renal vein (LRV) was compressed between SMA and AA.

Case presentation: A 32-year-old female patient presented with complaints of gradually severe bloating, epigastric pain, left flank ache, nausea and occasional vomiting of 1 month's duration. The epigastric and left flank ache was aggravated when the patient was supine and relieved in a prone or left lateral decubitus. The abdominal bloating was associated with early satiety. The vomiting always started 40 min after meal. The patient gave a history of urine stone with drotaverine hydrochloride tablets treatment for two weeks before the gastrointestinal symptoms arising. The patient had no significant surgical history, but had a rapid weight loss of approximately 10 kg with a body mass index (BMI) from 21 kg/m2 to less than 18 kg/m2 over the last two months. An abdominal examination revealed upper abdominal tenderness and distention. The urine routine examination showed no significant abnormality. The findings of initial blood tests and other laboratory investigations were unremarkable.

Conclusions: This case reports a female patient with SMA syndrome with Nutcracker syndrome predisposed by Antispasmodics. We highlight the importance of the combination therapy of long-term nutritional supporting and prokinetic agents. Rehabilitating practice after discharge is beneficial to reduce recurrence.

Keywords: Nutcracker syndrome; Superior mesenteric artery.

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Not applicable.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
CT imaging showing SMA syndrome and Nutcracker Syndrome. (a) Coronal view of gastroduodenal dilation (arrow). (b) Sagittal view of aortomesenteric region. The angle between the AA “A” and the SMA “B” was less than 35° (measured at 13°) (c) The third portion of the duodenum was compressed by the decreased aortomesenteric angle in the transverse plane. The compressed LRV between the AA “A” and the SMA “B” was showed as arrow (bird beak sign). The dilation LRV was showed as star. The zoomed structures presented in the lower left. (d) Three-dimensional reconstruction of the AA “A” and the SMA “B”
Fig. 2
Fig. 2
Upper gastrointestinal series/Upper gastrointestinal double-contrast radiograph. A vertical band of extrinsic compression (arrow) on the mid transverse part of duodenum compressed by SMA with proximal duodenal dilatation (star)
Fig. 3
Fig. 3
Follow-up BMI data collection. (a) The timeline of the disease course in this case report. (b) The follow-up BMI data collection. Hosp: hospitalization, F-nutri: family nutrition support, Susp: suspend
See this image and copyright information in PMC

References

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