SMA with Nutcracker Syndrome and Median Arcuate Ligament Compression: A Rare Anatomical Coexistence.

Superior mesenteric artery (SMA) syndrome or Wilkie’s syndrome is a rare cause of proximal intestinal obstruction due to compression of the third portion of the duodenum between the SMA and aorta. It can be associated with left renal vein entrapment called Nutcracker Syndrome. Median arcuate ligament (MAL) compression of the celiac trunk can further complicate the presentation. We report the case of a 17-year-old female with known SMA syndrome associated with nutcracker syndrome and radiological findings suggestive of median arcuate ligament compression. She presented with chronic postprandial abdominal pain, nausea, and significant weight loss. After failed conservative management including enteral and parenteral feeding trials, she underwent a successful laparoscopic gastrojejunostomy. Follow up revealed weight gain and improved clinical picture. This case highlights the diagnostic and therapeutic challenges in dual vascular compression syndromes.