A Model Example: Coexisting Superior Mesenteric Artery Syndrome and the Nutcracker Phenomenon.

Area of Science:

• Gastroenterology
• Vascular Surgery
• Radiology

Background:

• Superior mesenteric artery (SMA) syndrome is a rare condition causing gastrointestinal obstruction due to duodenal compression by the SMA.
• The Nutcracker phenomenon involves external compression of the left renal vein.
• Coexistence of SMA syndrome and Nutcracker phenomenon is infrequently reported.

Purpose of the Study:

• To report a rare case of concurrent SMA syndrome and Nutcracker phenomenon.
• To highlight this combination as a potential cause of acute abdomen.
• To emphasize the importance of considering rare diagnoses in nonspecific abdominal presentations.

Main Methods:

• Case report of a 19-year-old female presenting with acute epigastric pain and emesis.
• Clinical evaluation for gastrointestinal obstruction and vascular compression.
• Review of literature on coexisting SMA syndrome and Nutcracker phenomenon.

Main Results:

• The patient presented with symptoms consistent with SMA syndrome.
• The Nutcracker phenomenon was also identified.
• No typical clinical manifestations of Nutcracker syndrome were present in this case.

Conclusions:

• The coexistence of SMA syndrome and Nutcracker phenomenon is rare but clinically significant.
• This combination can present as an acute abdomen and may be missed with initial investigations.
• Conservative management is typically the first-line approach for SMA syndrome.