Superior mesenteric artery syndrome with associated nutcraker syndrome

Case contributed by Dr Achoki Daniel

Presentation

12 year history of early satiety, vomiting, weight loss, and intermittent haematuria

Patient Data

Age: 20 years
Gender: Male

The stomach and first and second parts of the duodenum are grossly dilated. The rest of the small bowel is collapsed. The aorto-mesenteric distance is 0.14cm while the aorto-mesenteric angle is 10.7 degrees. The left renal vein is clearly compressed at the point where it passes between the aorta and superior mesenteric artery.

Nutcracker syndrome gets its name from the fact that the compression of the left renal vein is like that of a nutcracker crushing a nut on the saggital view.

The nut is the compressed left renal vein. The posterior handle of the nutcracker is the aorta while the anterior handle is the superior mesenteric artery.

Case Discussion

Superior mesenteric artery syndrome is characterized by compression of the third portion of the duodenum between the aorta and superior mesenteric artery. This causes chronic duodenal obstruction. In our patient, it resulted in chronic history of early satiety, vomiting, and weight loss.

 

 

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Case information

rID: 62829
Published: 15th Sep 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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