Background: Both superior mesenteric artery (SMA) syndrome and nutcracker (NC) syndrome are rare vascular compression disorders caused by entrapment between the abdominal aorta and the SMA. While both conditions are uncommon, their coexistence has rarely been reported, primarily in young women. Both conditions have similar predisposing factors, most notably rapid weight loss, and both may present with non-specific gastrointestinal symptoms, which makes diagnosis challenging.Case report: We present the case of a 17-year-old female patient who presented with a three-month history of postprandial epigastric pain, early satiety, nausea, vomiting and progressive weight loss. Physical examination revealed severe malnutrition (BMI 15.1 kg/m²). Laboratory studies were unremarkable. Imaging revealed duodenal compression indicative of SMA syndrome, as well as concurrent compression of the left renal vein, consistent with the nutcracker phenomenon. Initially, conservative management involving nutritional rehabilitation and psychiatric support was attempted, but this failed due to poor oral tolerance and dietary non-compliance. Due to the persistence of symptoms and weight loss, the patient underwent Strong's procedure. Following the surgical procedure, the patient exhibited improved oral intake and a temporary resolution of presenting symptoms. She was discharged on day 2.On postoperative day 8, the patient reported a recurrence of symptoms, accompanied by significant anxiety and a belief that the surgical intervention had failed. A comprehensive physical examination and laboratory investigations were performed, which excluded any postoperative complications.The patient is currently being treated by the psychiatry and psychology teams for ongoing mental health support. We are still awaiting further progress in this case.Conclusion: This case study illustrates the rare occurrence of SMA and the NC phenomenon in an adolescent female patient, as well as the challenges involved in treating adolescents and their transition to adulthood.Early recognition, accurate imaging and a multidisciplinary approach are all crucial to effective management. While conservative treatment remains the first-line strategy, surgical intervention may be considered when conservative therapy fails. Reporting such cases adds to the limited literature and reinforces the importance of considering vascular compression syndromes in adolescents with unexplained gastrointestinal symptoms and weight loss.
