Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202501633
Jornal Vascular Brasileiro
Case Report

Compresión abdominal vascular triple – coexistencia de síndrome de Dunbar, síndrome de Wilkie y fenómeno de Nutcracker: reporte de caso y revisión de la literatura

Triple abdominal vascular compression: coexistence of Dunbar syndrome, Wilkie syndrome, and Nutcracker phenomenon: a case report and literature review

Bárbara Dieck-Gutiérrez; Juan Carlos Gómez-Rodríguez; Oscar Gabriel Villamizar-Blanco; Mauricio Carlos Durango-Tirado; Wilber Edison Peña-Niño; Gabriel Arroyave-Uribe; Hernán Dario Restrepo-Restrepo; Andrés Cadavid-Congote

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Resumen

El síndrome del ligamento arcuato mediano (síndrome de Dunbar) se caracteriza por la compresión del tronco celíaco, causando dolor abdominal posprandial y síntomas isquémicos. El síndrome de la arteria mesentérica superior (síndrome de Wilkie) resulta de la disminución del ángulo aortomesentérico, ocasionando obstrucción duodenal y pérdida de peso. Por su parte, el fenómeno de Nutcracker corresponde a la compresión de la vena renal izquierda entre la aorta y la arteria mesentérica superior. Si bien estas entidades son poco frecuentes de manera aislada, su coexistencia en un mismo paciente es excepcional, lo que dificulta el diagnóstico y el tratamiento. Presentamos el caso de una mujer joven con diagnóstico simultáneo de las tres patologías, tratada con éxito mediante abordaje quirúrgico. Se discuten los métodos diagnósticos y las alternativas terapéuticas, enfatizando la importancia de mantener un elevado índice de sospecha clínica para lograr un manejo oportuno y adecuado de estos síndromes compresivos infrecuentes.

Palabras clave

síndrome de ligamento arcuato medio; síndrome de arteria mesentérica superior; síndrome de cascanueces renal; informes de caso

Abstract

Median arcuate ligament syndrome (Dunbar syndrome) is characterized by compression of the celiac trunk, causing postprandial abdominal pain and ischemic symptoms. Superior mesenteric artery syndrome (Wilkie’s syndrome) results from narrowing of the aortomesenteric angle, leading to duodenal obstruction and weight loss. Nutcracker phenomenon, in turn, consists of compression of the left renal vein between the aorta and the superior mesenteric artery. While each of these entities are individually uncommon, their coexistence in a single patient is exceptionally rare and poses significant diagnostic and therapeutic challenges. We report the case of a young woman diagnosed simultaneously with all three conditions who was successfully managed through a surgical approach. Diagnostic methods and therapeutic options are discussed, highlighting the importance of maintaining a high index of suspicion for the timely and appropriate management of these uncommon compressive syndromes.

Keywords

median arcuate ligament syndrome; superior mesenteric artery syndrome; renal Nutcracker syndrome; case reports

References

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Submitted date:
10/23/2025

Accepted date:
05/21/2026

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