Superior Mesenteric Artery and Nutcracker Syndromes in a Healthy 14-Year-Old
Girl Requiring Surgical Intervention after Failed Conservative Management.
The superior mesenteric artery is the second major vessel to arise
from the anterior surface of the abdominal aorta.
The duodenum and left renal vein pass between the aorta and the
SMA. SMA syndrome or Wilkie’s syndrome is the external compression
of the third part of the duodenum between the aorta
and the superior mesenteric artery.
It is an uncommon cause of duodenal obstruction most commonly
effecting females aged 10- 40 with an approximate
prevalence of 0.013-0.3% in the general population
Nutcracker syndrome is the compression of the
left renal vein in between the superior mesenteric artery and
the aorta.
This can lead to abdominal pain, macroscopic or microscopic
hematuria, renal failure and dilatation of collateral vessels.
Although SMA syndrome and NCS have related aetiologies the occurrence
of both together is highly unusual.
Both can be precipitated by weight loss via reduction in retroperitoneal fat,
or the result of surgical intervention; including correction of scoliosis
and anything which affects the anatomical relationship of
the vessels involved.
Therefore, both conditions are more common when there is an
excessively acute aortomesenteric angle or a
shortened aortomesenteric distance.
A previously fit and well 14-year-old female, presented to
the paediatric emergency department with generalised abdominal pain
and symptoms of constipation, there were no indications for admission
and she was discharged with laxatives.
Several months later she represented on two successive days with similar symptoms,
however, this time there was associated fresh blood per rectum.
Gastro Open J. 2020; 5(1): 1-3. doi: 10.17140/GOJ-5-132
