{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T12:07:40Z","timestamp":1782734860502,"version":"3.54.5"},"reference-count":24,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,11,5]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:p>Vascular compression syndromes, including median arcuate ligament syndrome (MALS) and nutcracker syndrome (NCS), are poorly understood and frequently delayed diagnoses. This case describes a young adult female presenting with chronic vomiting, abdominal pain and weight loss, with dependence on nasogastric feeding. Subsequent to her gastrointestinal symptoms, she developed haematuria and orthostatic intolerance. Investigations confirmed NCS and possible MALS, with superadded gastroparesis and bradygastria. Under the joint care of general and vascular surgeons, she underwent a gastrojejunostomy and panelled renocaval bypass which led to partial resolution of her symptoms. It is hypothesised that gastroparesis may have been caused by MALS via a neurogenic mechanism, or coexistent compression of the duodenum by the superior mesenteric artery. This case highlights the difficulty in diagnosis of vascular compression syndromes, the overlap between the conditions and the potential for multiple coexistent conditions which complicate diagnosis and lead to increased lead-time and morbidity for patients.<\/jats:p>","DOI":"10.1136\/bcr-2023-257754","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T12:41:40Z","timestamp":1700570500000},"page":"e257754","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Atypical case of coexistent vascular compression syndromes: median arcuate ligament syndrome and nutcracker syndrome"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6727-9438","authenticated-orcid":false,"given":"Liam","family":"Donnelly","sequence":"first","affiliation":[{"name":"London North West University Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedict","family":"Turner","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alun H","family":"Davies","sequence":"additional","affiliation":[{"name":"Academic Section of Vascular Surgery, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,11,21]]},"reference":[{"key":"2025082801591950000_16.11.e257754.1","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1024\/0301-1526\/a000465","article-title":"Vascular compression syndromes","volume":"44","author":"Czihal","year":"2015","journal-title":"Vasa"},{"key":"2025082801591950000_16.11.e257754.2","doi-asserted-by":"crossref","DOI":"10.1186\/s13244-020-00852-z","article-title":"CT imaging findings of abdominopelvic vascular compression syndromes: what the radiologist needs to know","volume":"11","author":"Gozzo","year":"2020","journal-title":"Insights Imaging"},{"key":"2025082801591950000_16.11.e257754.3","doi-asserted-by":"publisher","DOI":"10.4065\/mcp.2009.0586"},{"key":"2025082801591950000_16.11.e257754.4","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics11010101","article-title":"From nutcracker phenomenon to nutcracker syndrome: a pictorial review","volume":"11","author":"Granata","year":"2021","journal-title":"Diagnostics (Basel)"},{"key":"2025082801591950000_16.11.e257754.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-006-0145-y"},{"key":"2025082801591950000_16.11.e257754.6","doi-asserted-by":"crossref","first-page":"277","DOI":"10.5527\/wjn.v3.i4.277","article-title":"Nutcracker syndrome","volume":"3","author":"Gulleroglu","year":"2014","journal-title":"World J Nephrol"},{"key":"2025082801591950000_16.11.e257754.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2010.08.044"},{"key":"2025082801591950000_16.11.e257754.8","doi-asserted-by":"publisher","DOI":"10.1148\/rg.341125010"},{"key":"2025082801591950000_16.11.e257754.9","first-page":"519","article-title":"Median arcuate ligament syndrome: a possible cause of idiopathic gastroparesis","volume":"92","author":"Balaban","year":"1997","journal-title":"Am J Gastroenterol"},{"key":"2025082801591950000_16.11.e257754.10","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1016\/j.radcr.2021.02.065","article-title":"A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome","volume":"16","author":"Farina","year":"2021","journal-title":"Radiology Case Reports"},{"key":"2025082801591950000_16.11.e257754.11","doi-asserted-by":"publisher","DOI":"10.1148\/rg.321115011"},{"key":"2025082801591950000_16.11.e257754.12","doi-asserted-by":"publisher","DOI":"10.1258\/vasc.2011.cr0320"},{"key":"2025082801591950000_16.11.e257754.13","doi-asserted-by":"crossref","first-page":"47","DOI":"10.5414\/CNP64047","article-title":"An ultrasonographic classification for diverse clinical symptoms of pediatric nutcracker phenomenon","volume":"64","author":"Takahashi","year":"2005","journal-title":"Clin Nephrol"},{"key":"2025082801591950000_16.11.e257754.14","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1177\/0333102420918554","article-title":"Nutcracker syndrome mimicking new daily persistent headache: a case report","volume":"40","author":"Stubberud","year":"2020","journal-title":"Cephalalgia"},{"key":"2025082801591950000_16.11.e257754.15","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.021002","article-title":"Mast cell activation disorder and postural orthostatic tachycardia syndrome: a clinical association","volume":"10","author":"Kohno","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"2025082801591950000_16.11.e257754.16","doi-asserted-by":"crossref","unstructured":"Woestemeier A , Semaan A , Block A , et al . 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