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Multimodality Diagnosis of Mesenteric Ischemia

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Published on: July 21, 2023

SUPERIOR MESENTERIC ARTERY SYNDROME COUPLED WITH RENAL NUTCRACKER SYNDROME.

Sana Sharafat Ali¹, Shazad Hussain Waqar¹, Sajid Ali Shah¹

¹Department of General Surgery, PIMS, Islamabad-Pakistan.

Journal of Ayub Medical College, Abbottabad : JAMC

|November 25, 2024

Summary

Superior Mesenteric Artery (SMA) Syndrome and Renal Nutcracker Syndrome can occur together, often in young women. Surgical repositioning of the Left Renal Vein (LRV) and duodenojejunostomy successfully treated a patient with both conditions.

Keywords:

Dysmenorrhea; Haematuria; Renal Nutcracker Syndrome; Superior Mesenteric Artery Syndrome; Wilkies Syndrome; Vomiting

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Area of Science:

Vascular Surgery
Gastroenterology
Nephrology

Background:

Superior Mesenteric Artery (SMA) Syndrome and Renal Nutcracker Syndrome (RNS) are conditions caused by vascular compression.
SMA syndrome involves the third part of the duodenum, while RNS affects the left renal vein.
These syndromes often present in young, lean females with symptoms of obstruction and pelvic congestion.

Observation:

The patient presented with chronic bilious vomiting and unintentional weight loss.
She also reported dysmenorrhea, left flank pain, and microscopic hematuria.
These symptoms suggested a concurrent diagnosis of SMA syndrome and RNS.

Findings:

Surgical intervention included duodenojejunostomy and Left Renal Vein (LRV) repositioning.
The patient experienced an uneventful recovery post-surgery.
Significant improvement in oral intake and pain reduction was noted at 6 weeks.

Implications:

Combined SMA and RNS can be effectively managed with surgical intervention.
Surgical correction leads to improved patient outcomes and quality of life.
This case highlights the importance of considering multiple vascular compression syndromes.