Nutcracker Phenomenon With Wilkie’s Syndrome in a Patient With Rectal Cancer

Abstract

Entrapment of the left renal vein between superior mesenteric artery (SMA) and aorta can be asymptomatic or present as microscopic hematuria and orthostatic proteinuria. It can be associated with other abdominal vascular compression syndromes and duodenal obstruction. We present a 62-year-old Caucasian male patient with nutcracker phenomenon and SMA syndrome secondary to rectal cancer associated cachexia. Computed tomographic angiography is a non-invasive diagnostic modality which depicts it in great details. Its early clinical suspicion and radiologic assessment help in patient management to avert possible complications such as blood loss in already debilitating patients such as ours.

Superior Mesenteric Artery Syndrome Combined with Renal Nutcracker Syndrome in a Young Male: A Case Report

“…The summarized cases are shown in Table 1. [14][15][16][17][18][19][20] In our case, the patient's body mass index was relatively high, and surgical intervention to treat SMA syndrome was used uniquely. In all cases, the specific therapy for renal nutcracker syndrome was not needed due to the lack of hematuria or serious urinary symptoms, and the symptoms related to SMA syndrome were well resolved after treatment.…”

Laparoscopic paraaortic lymph node dissection in a patient with nutcracker syndrome for rectal cancer – a video vignette

“…The left renal vein is compressed by the sharp angle (< 25°) between the superior mesenteric artery (Iqbal, #5) and the aorta , which results in engorgement of the left renal vein and left ovarian vein . This syndrome has been reported in a rectal cancer patient with cachexia . We present a patient with an incidental finding of the nutcracker syndrome during laparoscopic paraaortic lymph node dissection for rectal cancer.…”

Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature

“…Given that both the duodenum and the LRV occupy a place within the same vascular angle, and that the compression of either structure is contingent upon a vascular angle that is significantly below the normal limit (< 38 degrees), it is curious that a double compression has been reported only a few times in the literature [ 2 , 108 – 113 ]. Although the aortomesenteric compression of the duodenum has often been widely attributed to excessive weight loss, the same argument has not been consistently made for the aortomesenteric compression of the LRV.…”

“…There are only a few reported cases in the literature that describe patients with radiological evidence of the compression of both the duodenum and the LRV [ 2 , 108 – 113 ], and there is only one report of a patient who had both the radiological and clinical evidence for both disorders [ 112 ]. The case presented in this report is unique in that it is the first in the literature to describe a patient who was diagnosed as having both SMAS and NCS, and who required two separate surgeries to resolve all clinical symptoms.…”