Objectives
This article describes the presentation and management of two vascular compressive syndromes occurring within the same patient. Median arcuate ligament syndrome (MALS) presents as chronic mesenteric ischemia secondary to compression of the celiac trunk by the median arcuate ligament. Treatment by surgical decompression can provide relief. Nutcracker syndrome presents as vague flank or pelvic pain along with hematuria. It occurs secondary to compression of the left renal vein (LRV) by the superior mesenteric artery (SMA). Transposition of the LRV has been described to manage symptoms. Rarely do these two compressive syndromes occur simultaneously.
Methods
A 33-year-old man presented with chronic abdominal/flank pain, nausea/vomiting, and hematuria. Physical examination, biochemical analysis, and endoscopic and fluoroscopic evaluations did not reveal an etiology. Contrasted computed tomography revealed extrinsic compression of the celiac trunk consistent with MALS. In addition, the presence of LRV compression (with poststenotic dilatation) by the SMA was consistent with nutcracker syndrome.
Results
The patient underwent simultaneous open release of the MAL along with LRV transposition. His postoperative course was unremarkable. The patient reported a marked improvement in his abdominal symptoms.
Conclusions
Vascular compressive syndromes, such as MAL and nutcracker syndromes, occur infrequently. Surgical intervention can provide symptomatic relief in properly selected patients.
Article Info
Footnotes
Disclosures: S. Iranmanesh: Nothing to disclose; B. W. Howell: Nothing to disclose; J. J. Ricotta: Nothing to disclose
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Copyright
© 2014 Published by Elsevier Inc.
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