Wilkie syndrome combined with nutcracker syndrome presented as syncopal episodes: A case report.

Combined aortomesenteric compression is an extremely rare vascular condition where both the duodenum (Wilkie) and the left renal vein (nutcracker) are compressed between the aorta and the superior mesenteric artery (SMA). The causal factor is the abnormal course of the SMA originating from the abdominal aorta with reduced angle. Here we describe the case of a young male patient presenting with repetitive episodes of loss of consciousness, arrhythmias and hyperamylasemia, not associated with other symptoms. Color Doppler revealed an aortomesenteric angle of 15°, compression of the left renal vein and the third part of the duodenum. An abdominal Computed Tomography (CT) scan confirmed the ultrasound findings. Cardiological examination with 24-hour Holter monitoring reported frequent premature ventricular contractions (PVC). In lean patients with syncopal episodes and abnormal amylase levels, combined aortomesenteric compression syndrome should be considered. Patients with nutcracker syndrome have to be evaluated for autonomic nervous system dysfunction.