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Review
. 2020 Aug 9:21:e922619.
doi: 10.12659/AJCR.922619.

Combined Superior Mesenteric Artery Syndrome and Nutcracker Syndrome in a Young Patient: A Case Report and Review of the Literature

Samer Diab  1 , Fadi Hayek  2
Affiliations
Review

Combined Superior Mesenteric Artery Syndrome and Nutcracker Syndrome in a Young Patient: A Case Report and Review of the Literature

Samer Diab et al. Am J Case Rep. .

Abstract

BACKGROUND Superior mesenteric artery syndrome is the compression of the third portion of the duodenum between the superior mesenteric artery and the aorta causing abdominal pain and vomiting. Nutcracker syndrome is the compression of the left renal vein between the superior mesenteric artery and the aorta causing symptoms related to renal congestion. Both entities, although well described in the literature, are individually rare, and even though they might share a common etiology, their co-existence has been reported in only a few case reports. CASE REPORT An 18-year-old male, previously healthy, presented with postprandial abdominal pain relieved by bilious vomiting that started shortly after he lost weight fasting. Our investigation revealed superior mesenteric artery syndrome as well as a compressed left renal vein. He was started on an enriched fluid diet which was progressed gradually as he regained weight. His left renal vein compression at the time was asymptomatic; it will be followed up for possible resolution after the patient's weight returns to normal. CONCLUSIONS Superior mesenteric artery syndrome is to be suspected in patients with abdominal pain following weight loss. Conservative treatment with a focus on weight regain will cure most cases. Asymptomatic or mildly symptomatic nutcracker syndrome is treated conservatively. For patients requiring intervention, laparoscopic extravascular titanium stent placement seems to be the least invasive promising option today, awaiting further definitive studies.

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Conflict of interest statement

Conflict of interest: None declared

Conflict of interest

None.

Figures

Figure 1.
Figure 1.
Computed tomography angiography showing the incidental finding of a horseshoe kidney (red arrow).
Figure 2.
Figure 2.
Computed tomography angiography showing the compression of the duodenum (Du) between the superior mesenteric artery (SMA) and the aorta.
Figure 3.
Figure 3.
Computed tomography angiography showing the left renal vein (LRV) compression between the superior mesenteric artery (SMA) and the aorta.
Figure 4.
Figure 4.
Sagittal computed tomography angiography showing the acute takeoff of the superior mesenteric artery from the aorta at an angle of 12.7 degrees.
See this image and copyright information in PMC

References

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