Superior Mesenteric Artery and Nutcracker Syndromes in a Healthy 14-Year-Old Girl Requiring Surgical Intervention after Failed Conservative Management

Abstract

This case report presents the diagnosis of superior mesenteric artery and nutcracker syndromes in a previously fit and well 14-yearold
girl. Although these two entities usually occur in isolation, despite their related aetiology, our patient was a rare example of
their occurrence together. In this case the duodenal compression of superior mesenteric artery syndrome caused intractable vomiting
leading to weight loss, and her nutcracker syndrome caused severe left-sided abdominal pain and microscopic haematuria
without renal compromise. Management of the superior mesenteric artery syndrome can be conservative by increasing the weight
of the child which leads to improvement of retroperitoneal fat and hence the angle of the artery. The weight can be improved
either by enteral feeds or parenteral nutrition. This conservative management initially helped but not in the long-term as the child
started losing weight again. The next step in management is surgery (duodenojejunostomy – if the conservative management fails),
which the child went through, remarkably improving their symptoms.