Superior Mesenteric Artery Syndrome With Nutcracker Phenomenon in an Ulcerative Colitis Patient: A Case Report and Literature Review.

Superior mesenteric artery syndrome (SMAS) and nutcracker phenomenon or syndrome (if with symptoms) are rare conditions. The former is caused by the compression of the third part of the duodenum between the aorta and the superior mesenteric artery (SMA), leading to duodenal obstruction, while the latter is caused by the compression of the left renal vein between the SMA and the aorta, leading to distal dilation of the vein. Coexistence of both conditions is extremely rare, and up to 2017, only 8 cases were reported. Upon literature review, a few case reports linked either SMAS or the nutcracker phenomenon with Crohn's disease. To the best of our knowledge, no ulcerative colitis case diagnosed concurrently with SMAS or nutcracker syndrome was found. We report the case of a 20-year-old woman with active ulcerative colitis who presented with a flare-up as well as weight loss, nausea, and vomiting. In addition to her active ulcerative colitis, she was found to have concurrent SMAS and the nutcracker phenomenon upon radiological investigations. SMAS and the nutcracker phenomenon are extremely rare to occur concurrently. Management of such cases can be challenging and ranges from nutritional support to surgical interventions.