Superior Mesenteric Artery Syndrome With Nutcracker Phenomenon in an Ulcerative Colitis Patient: A Case Report and Literature Review

IF 3.3

Gastro hep advances Pub Date : 2026-01-01 Epub Date: 2026-06-24 DOI:10.1016/j.gastha.2026.101041

Abdulla Alabed, Mohamed Wael, Mariam Adnan, Mohamed Alabbasi, Nawara Aljasim, Sara Altamimi, Faisal Abubaker, Omar Sharif

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Abstract

Superior mesenteric artery syndrome (SMAS) and nutcracker phenomenon or syndrome (if with symptoms) are rare conditions. The former is caused by the compression of the third part of the duodenum between the aorta and the superior mesenteric artery (SMA), leading to duodenal obstruction, while the latter is caused by the compression of the left renal vein between the SMA and the aorta, leading to distal dilation of the vein. Coexistence of both conditions is extremely rare, and up to 2017, only 8 cases were reported. Upon literature review, a few case reports linked either SMAS or the nutcracker phenomenon with Crohn’s disease. To the best of our knowledge, no ulcerative colitis case diagnosed concurrently with SMAS or nutcracker syndrome was found. We report the case of a 20-year-old woman with active ulcerative colitis who presented with a flare-up as well as weight loss, nausea, and vomiting. In addition to her active ulcerative colitis, she was found to have concurrent SMAS and the nutcracker phenomenon upon radiological investigations. SMAS and the nutcracker phenomenon are extremely rare to occur concurrently. Management of such cases can be challenging and ranges from nutritional support to surgical interventions.

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溃疡性结肠炎患者肠系膜上动脉综合征伴胡桃夹子现象1例报告并文献复习

肠系膜上动脉综合征（SMAS）和胡桃夹子现象或综合征（如果有症状）是罕见的情况。前者是由于主动脉与肠系膜上动脉（SMA）之间的十二指肠第三段受到压迫，导致十二指肠梗阻，后者是由于SMA与主动脉之间的左肾静脉受到压迫，导致静脉远端扩张。两种情况并存的情况极为罕见，截至2017年，仅报告了8例。根据文献回顾，一些病例报告将SMAS或胡桃夹子现象与克罗恩病联系起来。据我们所知，没有溃疡性结肠炎病例同时诊断为SMAS或胡桃夹子综合征被发现。我们报告一例20岁的女性与活动性溃疡性结肠炎谁提出了爆发以及体重减轻，恶心和呕吐。除了活动性溃疡性结肠炎外，经放射检查发现她同时患有SMAS和胡桃夹子现象。SMAS和胡桃夹子现象同时发生是极其罕见的。这些病例的管理可能具有挑战性，从营养支持到手术干预。肠系膜上动脉综合征（SMAS）和胡桃夹子现象或综合征（如果有症状）是罕见的情况。前者是由于主动脉与肠系膜上动脉（SMA）之间的十二指肠第三段受到压迫，导致十二指肠梗阻，后者是由于SMA与主动脉之间的左肾静脉受到压迫，导致静脉远端扩张。两种情况并存的情况极为罕见，截至2017年，仅报告了8例。根据文献回顾，一些病例报告将SMAS或胡桃夹子现象与克罗恩病联系起来。据我们所知，没有溃疡性结肠炎病例同时诊断为SMAS或胡桃夹子综合征被发现。我们报告一例20岁的女性与活动性溃疡性结肠炎谁提出了爆发以及体重减轻，恶心和呕吐。除了活动性溃疡性结肠炎外，经放射检查发现她同时患有SMAS和胡桃夹子现象。SMAS和胡桃夹子现象同时发生是极其罕见的。这些病例的管理可能具有挑战性，从营养支持到手术干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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