A Rare Case of Coexisting Superior Mesenteric Artery Syndrome and Nutcracker Phenomenon

The patient also underwent a gastroduodenoscopy which did not reveal any intrinsic obstructions. Since he had normal renal function parameters with normal blood pressure, no further intervention was deemed necessary to treat the nutcracker phenomenon. Comment The extrinsic compression of the third p...

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Bibliographic Details
Published in:Sultan Qaboos University medical journal 2017-08, Vol.17 (3), p.368-370
Main Authors: Al-Saadi , Tahra, Michael , Philips G, Jamkhandikar , Rakesh
Format: Article
Language:English
Subjects:
Abdomen
Adult
ARTERY OCCLUSION
Body Mass Index
Constriction, Pathologic - diagnostic imaging
Coronary vessels
Humans
Interesting Medical Image
Male
Mesenteric Artery, Superior
Nutrition
OMAN
Pain
Patients
RAYNAUD'S PHENOMENON
RAYS
Renal Nutcracker Syndrome - complications
Renal Nutcracker Syndrome - diagnostic imaging
Superior Mesenteric Artery Syndrome - complications
Superior Mesenteric Artery Syndrome - diagnostic imaging
SUPERIORITY COMPLEX
Tomography
Tomography, X-Ray Computed
Veins & arteries
Vomiting
Weight Loss
الأشعة
الإنسداد الشرياني
ظاهرة رينود
عقدة العظمة
عمان
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Summary:The patient also underwent a gastroduodenoscopy which did not reveal any intrinsic obstructions. Since he had normal renal function parameters with normal blood pressure, no further intervention was deemed necessary to treat the nutcracker phenomenon. Comment The extrinsic compression of the third part of the duodenum between the SMA and the abdominal aorta as the artery crosses the duodenum anteriorly—known as SMA syndrome—is a rare cause of upper gastrointestinal obstruction.1 Patients may present with chronic or vague postprandial symptoms, such as upper abdominal pain, nausea, vomiting, weight loss and a feeling of early satiety or bloating, although acute presentations with symptoms of duodenal obstruction have also been described.1,2 The syndrome occurs due to an abnormally acute angle between the proximal part of the SMA and the abdominal aorta which ranges from 6–16 degrees in symptomatic patients compared to 38–56 degrees in normal individuals; this results in duodenal compression and a reduced mean AMD of 2–8 mm in symptomatic patients compared to normal mean values of 10–28 mm.3 Abnormally steep angulation between the SMA and the aorta can cause a short AMD and predispose to nutcracker syndrome.2 A significantly decreased AMD of 3 mm and decreased AA of
ISSN:2075-051X
2075-0528
DOI:10.18295/squmj.2017.17.03.022