Nutcracker Syndrome Associated With Wilkie’s Syndrome: A Case Report

TL;DR

A rare case of two overlapping vascular compression disorders, Nutcracker and Wilkie’s syndromes, is reported in a patient with evolving abdominal symptoms.

Contribution

This case highlights the rare coexistence of Nutcracker and Wilkie’s syndromes and their shared anatomical cause.

Findings

The patient initially presented with Nutcracker syndrome, confirmed by imaging of left renal vein compression.

Two years later, Wilkie’s syndrome was diagnosed due to a narrowed aortomesenteric angle and duodenal compression.

Conservative management and multidisciplinary follow-up were effective for both conditions.

Abstract

Nutcracker syndrome and Wilkie’s syndrome are rare vascular compression disorders that share a common anatomical etiology, a reduced aortomesenteric angle leading to the compression of the left renal vein and the third portion of the duodenum, respectively. The coexistence of both syndromes is extremely rare. We report the case of a 32-year-old female patient with recurrent left flank pain and gastrointestinal symptoms. The initial imaging revealed a compression of the left renal vein consistent with the nutcracker syndrome. Conservative treatment was initiated. Two years later, she developed postprandial epigastric pain and dyspepsia. Further imaging demonstrated a significant narrowing of the aortomesenteric angle, duodenal compression, and gastric dilatation, confirming the coexistence of Wilkie’s syndrome. Management remained conservative, with multidisciplinary follow-up. This case emphasizes the importance of considering overlapping vascular compression syndromes in patients with evolving abdominal symptoms. Early recognition is crucial to avoid unnecessary investigations and to optimize clinical outcomes.

Figures