Al-Zoubi Nabil A
Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan.
Clin Med Insights Case Rep. 2019 Jun 17;12:1179547619855383. doi: 10.1177/1179547619855383. eCollection 2019.
The duodenum and the left renal vein (LRV) occupy the vascular angle made by the superior mesenteric artery (SMA) and the aorta. When the angle becomes too acute, compression of either structure can occur. Although superior mesenteric artery syndrome (SMAS) and renal Nutcracker syndrome (NCS) share the same pathogenesis, concurrent development has rarely been reported.
A 38-year-old female patient with a past history of gastrojejunostomy operated 6 years ago due to SMAS. She referred to vascular clinic with sever intermittent left-sided loin pain during the last 6 years. Computed tomography (CT)-angiogram and selective LRV angiogram with pressure gradient confirmed the diagnosis of NCS. She was treated by LRV transposition with uneventful recovery and considerable relief of symptoms.
NCS accompanying with SMAS is quite unusual. A patient, who first presents with clinical evidence of SMAS, could also simultaneously or sometime thereafter present with NCS and vice versa.
十二指肠和左肾静脉（LRV）位于肠系膜上动脉（SMA）与主动脉形成的血管夹角处。当该夹角变得过于狭窄时，这两个结构中的任何一个都可能受到压迫。虽然肠系膜上动脉综合征（SMAS）和肾胡桃夹综合征（NCS）具有相同的发病机制，但二者同时发生的情况鲜有报道。
一名38岁女性患者，6年前因SMAS接受了胃空肠吻合术。在过去6年中，她因严重的间歇性左侧腰痛前往血管科就诊。计算机断层扫描（CT）血管造影和选择性LRV血管造影及压力梯度测量确诊为NCS。她接受了LRV转位手术，术后恢复顺利，症状得到明显缓解。
NCS合并SMAS非常罕见。最初表现为SMAS临床症状的患者，也可能同时或之后出现NCS，反之亦然。
