Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202201612
Jornal Vascular Brasileiro
Case Report

Combined superior mesenteric artery syndrome and nutcraker syndrome presenting as acute pancreatitis: a case report

Síndrome da artéria mesentérica superior em combinação com síndrome de quebra-nozes manifestando-se como pancreatite aguda: relato de caso

Bárbara Neto Castro; Ana Rita Ferreira; Susana Graça; Manuel Oliveira

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Abstract

Abstract: Superior mesenteric artery syndrome designates compression of the third part of the duodenum between the superior mesenteric artery and the aorta. This condition has a low incidence, being more common in thin young women. Nutcracker syndrome is compression of the left renal vein between the superior mesenteric artery and the aorta. Both entities are rare, and their coexistence has been reported in a few cases. Conservative treatment targeting weight gain is sufficient in most cases. An association between the superior mesenteric artery syndrome and acute pancreatitis has rarely been reported. We intend to describe the case of an 18-year-old girl who was admitted to the emergency room with epigastric pain and emesis. Our investigation revealed acute acalculous pancreatitis. During work-up, we discovered superior mesenteric artery syndrome and a compressed left renal vein. The patient is on conservative treatment, and her symptoms have improved.

Keywords

superior mesenteric artery syndrome, nutcracker syndrome, acute pancreatitis, rare diseases

Resumo

Resumo: A síndrome da artéria mesentérica superior designa compressão da terceira parte do duodeno pela artéria mesentérica superior e a aorta. Essa condição tem uma baixa incidência, sendo mais comum em mulheres jovens magras. A síndrome de quebra-nozes resulta da compressão da veia renal esquerda pela artéria mesentérica superior e a aorta. Ambas as entidades são raras, e a sua coexistência foi descrita em poucos casos. Tratamento conservador com o objetivo de ganho ponderal é suficiente na maioria dos casos. A associação entre a síndrome da artéria mesentérica superior e a pancreatite aguda foi raramente relatada. Pretendemos descrever o caso de uma jovem de 18 anos que recorreu ao serviço de urgência com epigastralgia e vômitos. A investigação realizada revelou pancreatite aguda alitiásica. Durante o estudo complementar, foi identificada a síndrome da artéria mesentérica superior, bem como uma veia renal esquerda comprimida. A paciente encontra-se em tratamento conservador, apresentando melhora clínica.
 

Palavras-chave

síndrome da artéria mesentérica superior, síndrome de quebra-nozes, pancreatite aguda, doenças raras

References

1 Diab S, Hayek F. Combined superior mesenteric artery syndrome and nutcracker syndrome in a young patient: a case report and review of the literature. Am J Case Rep. 2020;21:e922619. http://dx.doi.org/10.12659/AJCR.922619. PMid:32772039.

2 Farina R, Iannace FA, Foti PV, et al. A case of nutcracker syndrome combined with Wilkie syndrome with unusual clinical presentation. Am J Case Rep. 2020;21:e922715. http://dx.doi.org/10.12659/AJCR.922715. PMid:32317620.

3 Ruffle JK, Power N, Aziz Q. Abdominal pain presenting as a tight squeeze on a Tchaikovsky score. Gastroenterology. 2019;156(3):e3-5. http://dx.doi.org/10.1053/j.gastro.2018.09.031. PMid:30240663.

4 Berdugo Hurtado F, Díaz Alcázar MM, Torrecillas Cabrera MM, Miras Ventura JA. Aortomesenteric clamp: association with Wilkie syndorme and nutcracker syndrome. Rev Esp Enferm Dig. 2021;113(5):372-4. http://dx.doi.org/10.17235/reed.2021.7580/2020. PMid:33406845.

5 Oh MJ. Superior mesenteric artery syndrome combined with renal nutcracker syndrome in a young male: a case report. Korean J Gastroenterol. 2017;70(5):253-60. http://dx.doi.org/10.4166/kjg.2017.70.5.253. PMid:29161795.

6 Farina R, Gozzo C, Foti PV, et al. A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome. Radiol Case Rep. 2021;16(6):1264-70. http://dx.doi.org/10.1016/j.radcr.2021.02.065. PMid:33854661.

7 Cienfuegos JA, Vivas Pérez I, Rotellar F. Co-occurrence of compression syndromes: celiac axis stenosis, superior mesenteric artery and nutcracker syndrome. Rev Esp Enferm Dig. 2020;112(11):885. http://dx.doi.org/10.17235/reed.2020.6945/2020. PMid:32755144.

8 Stubberud A, Cheema S, Tronvik E, Matharu M. Nutcracker syndrome mimicking new daily persistent headache: a case report. Cephalalgia. 2020;40(9):1008-11. http://dx.doi.org/10.1177/0333102420918554. PMid:32295399.

9 Lin TH, Lin CC, Tsai JD. Superior mesenteric artery syndrome and nutcracker syndrome. Pediatr Neonatol. 2020;61(3):351-2. http://dx.doi.org/10.1016/j.pedneo.2019.12.003. PMid:31902598.

10 Al-Zoubi NA. Nutcracker syndrome accompanying with superior mesenteric artery syndrome: a case report. Clin Med Insights Case Rep. 2019;12:1179547619855383. http://dx.doi.org/10.1177/1179547619855383. PMid:31244527.

11 Shi Y, Shi G, Li Z, Chen Y, Tang S, Huang W. Superior mesenteric artery syndrome coexists with nutcracker syndrome in a female: a case report. BMC Gastroenterol. 2019;19(1):15. http://dx.doi.org/10.1186/s12876-019-0932-1. PMid:30674275.

12 Heidbreder R. Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature. J Med Case Rep. 2018;12(1):214. http://dx.doi.org/10.1186/s13256-018-1743-7. PMid:30081961.

13 Osegueda de Rodríguez EJ, Hernández-Villegas AC, Serralde-Zúñiga AE, Reyes-Ramírez A. The two sides of superior mesenteric artery syndrome treatment: conservative or surgical management? Nutr Hosp. 2017;34(4):997-1000. PMid:29095027.

14 Michael PG, Al-Saadi T, Jamkhandikar R. A rare case of coexisting superior mesenteric artery syndrome and nutcracker phenomenon. Sultan Qaboos Univ Med J. 2017;17(3):e368-70. http://dx.doi.org/10.18295/squmj.2017.17.03.022. PMid:29062567.

15 Jomni T, Larguech M, Abdelaali I, Charfi M, Dougui MH. Anemia revealing a rare association: superior mesenteric artery syndrome and nutcracker syndrome. Tunis Med. 2016;94(2):162-3. PMid:27532538.

16 Alenezy A, Obaid AD, Qattan AA, Hamad A. Superior mesenteric artery syndrome and nutcracker phenomenon. Saudi J Med Med Sci. 2014;2(3):223-5. http://dx.doi.org/10.4103/1658-631X.142587.

17 Estraviz B, Arévalo JA, Eizaguirre E, et al. Laparoscopic approach for the multiple abdominal vascular entrapment syndrome. Hepatogastroenterology. 2012;59(113):175-7. PMid:22251534.

18 Felton BM, White JM, Racine MA. An uncommon case of abdominal pain: superior mesenteric artery syndrome. West J Emerg Med. 2012;13(6):501-2. http://dx.doi.org/10.5811/westjem.2012.6.12762. PMid:23358897.

19 Claro M, Sousa D, Silva AA, Grilo J, Martins JA. Wilkie’s syndrome: an unexpected finding. Cureus. 2021;13(12):e20413. PMid:35047254.

20 Waseem M, Upadhyay R, Prosper G. The nutcracker syndrome: an underrecognized cause of hematuria. Eur J Pediatr. 2012;171(8):1269-71. http://dx.doi.org/10.1007/s00431-012-1761-1. PMid:22696107.

21 Ammaturo C, Giardiello C, Piscitelli L, Romano C, Pascotto R, Formato M. The superior mesenteric artery syndrome: a rare cause of acute pancreatitis. Panminerva Med. 1988;30(2):114-7. PMid:2459651.

22 Gwee K, Teh A, Huang C. Acute superior mesenteric artery syndrome and pancreatitis in anorexia nervosa. Australas Psychiatry. 2010;18(6):523-6. http://dx.doi.org/10.3109/10398562.2010.498885. PMid:20932197.

23 Sihuay-Diburga DJ, Accarino-Garaventa A, Vilaseca-Montplet J, Azpiroz-Vidaur F. Acute pancreatitis and superior mesenteric artery syndrome. Rev Esp Enferm Dig. 2013;105(10):626-8. http://dx.doi.org/10.4321/S1130-01082013001000009. PMid:24641461.

24 Kojima S, Suzuki K, Katayama N, Imai H. Superior mesenteric artery syndrome as a cause of acute pancreatitis. BMJ Case Rep. 2016;2016:bcr2016217073. http://dx.doi.org/10.1136/bcr-2016-217073. PMid:27646321.

25 Wang T, Wang ZX, Wang HJ. Clinical insights into superior mesenteric artery syndrome with multiple diseases: a case report. Dig Dis Sci. 2019;64(6):1711-4. http://dx.doi.org/10.1007/s10620-018-5436-2. PMid:30569335.
 


Submitted date:
12/26/2022

Accepted date:
04/10/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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