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
Resumen
Palabras clave
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
Referências
1 Loukas M, Pinyard J, Vaid S, Kinsella C, Tariq A, Tubbs RS. Clinical anatomy of celiac artery compression syndrome: a review. Clin Anat. 2007;20(6):612-7.
2 Goodall R, Langridge B, Onida S, Ellis M, Lane T, Davies AH. Median arcuate ligament syndrome. J Vasc Surg. 2020;71(6):2170-6.
3 Lee TH, Lee JS, Jo Y, et al. Superior mesenteric artery syndrome: where do we stand today? J Gastrointest Surg. 2012;16(12):2203-11.
4 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.
5 Danushka PGN, Jayasinghe R, Wijemanne A. Superior mesenteric artery syndrome treatment strategies: a case report. SAGE Open Med Case Rep. 2023;11:X231184587.
6 Navandhar PS, Shinde RK, Gharde P, Nagtode T, Badwaik N. Understanding superior mesenteric artery syndrome: etiology, symptoms, diagnosis, and management. Cureus. 2024;16(6):e61532.
7 Castro BN, Ferreira AR, Graça S, Oliveira M. Combined superior mesenteric artery syndrome and nutcraker syndrome presenting as acute pancreatitis: a case report. J Vasc Bras. 2023;22:e20220161.
8 Oka A, Awoniyi M, Hasegawa N, et al. Superior mesenteric artery syndrome: diagnosis and management. World J Clin Cases. 2023;11(15):3369-84.
9 Tseng CK, Su WB, Lai HC, et al. Superior mesenteric artery syndrome caused by celiac axis compression syndrome: a case report and review of the literature. Eur J Gastroenterol Hepatol. 2008;20(6):578-82.
10 Vásquez-Arango JN, Durán-Meléndez MA, Vásquez-Maya C. Tratamiento mínimamente invasivo del síndrome de Wilkie. Rev Colomb Cir. 2018;33(3):299-306.
11 England J, Li N. Superior mesenteric artery syndrome: a review of the literature. J Am Coll Emerg Physicians Open. 2021;2(3):e12454.
12 Lakkanna A, Reddy D, Babu B, Pentakota N, Subbiah Nagaraj S. Abdominal pain associated with celiac artery compression and Superior Mesenteric Artery (SMA) syndrome: a case report. Cureus. 2024;16(9):e70520.
13 Sianesi M, Soliani P, Arcuri MF, Bezer L, Iapichino G, Del Rio P. Dunbar’s syndrome and superior mesenteric artery’s syndrome: a rare association. Dig Dis Sci. 2007;52(1):302-5.
14 Mathenge N, Osiro S, Rodriguez II, Salib C, Tubbs RS, Loukas M. Superior mesenteric artery syndrome and its associated gastrointestinal implications. Clin Anat. 2014;27(8):1244-52.
15 Ganss A, Rampado S, Savarino E, Bardini R. Superior mesenteric artery syndrome: a prospective study in a single institution. J Gastrointest Surg. 2019;23(5):997-1005.
16 Doyle AJ, Chandra A. Chronic mesenteric ischemia in a 26-year-old man: multivessel median arcuate ligament compression syndrome. Ann Vasc Surg. 2012;26(1):108.e5-9.
17 Gruber H, Loizides A, Peer S, Gruber I. Ultrasound of the median arcuate ligament syndrome: a new approach to diagnosis. Med Ultrason. 2012;14(1):5-9. PMid:22396932.
18 Ozel A, Toksoy G, Ozdogan O, Mahmutoglu AS, Karpat Z. Ultrasonographic diagnosis of median arcuate ligament syndrome: a report of two cases. Med Ultrason. 2012;14(2):154-7. PMid:22675717.
19 Narwani P, Khanna N, Rajendran I, Kaawan H, Al-Sam R. Median arcuate ligament syndrome diagnosis on Computed Tomography: what a radiologist needs to know. Radiol Case Rep. 2021;16(11):3614-7.
20 Wasef K, Hudnall A, Schmidt CR, Marsh JW, Boone BA. Robotic modified Strong procedure for superior mesenteric artery syndrome. Clin Case Rep. 2023;11(7):e7651.
21 Kirby GC, Faulconer E, Robinson S, Perry A, Downing R. Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice. Ann R Coll Surg Engl. 2017;99(6):472-5.
22 Ben Abdallah I, Cerceau P, Pellenc Q, Huguet A, Corcos O, Castier Y. Laparoscopic surgery in chronic mesenteric ischemia: release of the superior mesenteric artery from the median arcuate ligament using the transperitoneal left retrorenal approach. Ann Vasc Surg. 2019;59:313.e5-10.
23 Lu SB, Guo Y, Chen R, Zhang Y. Laparoscopic surgery for superior mesenteric artery syndrome. J Invest Surg. 2024;37(1):2387524.
Submetido em:
23/10/2025
Aceito em:
21/05/2026
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email