CASE REPORT: SUPERIOR MESENTERIC ARTERY SYNDROME COMBINED WITH NUTCRACKER SYNDROME
Main Article Content
Abstract
Background: Superior Mesenteric Artery (SMA) Syndrome is a rare condition caused by mechanical compression of the third portion (D3) of the duodenum between the superior mesenteric artery and the abdominal aorta. In some cases, concurrent compression of the left renal vein between these two vessels may also occur, known as Nutcracker Syndrome. This represents an uncommon cause of chronic duodenal obstruction, which is often overlooked in clinical practice due to its nonspecific symptoms. Case presentation: We report a case of a 35-year-old male patient admitted with epigastric abdominal pain and postprandial vomiting. Upright abdominal radiography, upper gastrointestinal contrast radiography, and contrast-enhanced abdominal computed tomography (CT) revealed dilatation of the D1-D2 duodenum and the proximal jejunum, accompanied by narrowing of the D3 segment due to compression between the superior mesenteric artery and the abdominal aorta. The aortomesenteric angle was approximately 19.5°, with an aortomesenteric distance of 6 mm. In addition, CT findings also demonstrated compression of the left renal vein between the two vessels, suggesting concurrent Nutcracker Syndrome. Discussion: This case illustrates the characteristic imaging features of SMA Syndrome in association with Nutcracker Syndrome. The diagnosis is primarily based on clinical symptoms and evidence of obstruction on contrast-enhanced gastrointestinal radiography, with definitive identification of the underlying vascular compression on contrast-enhanced abdominal CT. Conclusion: We present a typical case of SMA Syndrome associated with Nutcracker Syndrome, emphasizing the crucial role of contrast-enhanced computed tomography in detecting rare vascular compression syndromes in the abdomen.
Keywords
Superior mesenteric artery syndrome, superior mesenteric artery, abdominal aorta, nutcracker syndrome, vascular compression
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