BMJ Case Reports 2013; doi:10.1136/bcr-2013-008734

Superior mesenteric artery syndrome and the ‘nutcracker phenomenon’

  1. Dipankar Mukherjee1
  1. 1Department of General Surgery, Queen's Hospital, Romford, UK
  2. 2Department of Radiology, Queen's Hospital, Romford, UK
  1. Correspondence to Paul Vulliamy, paul.vulliamy{at}


A 55-year-old man presented with a 1-day history of vomiting, epigastric pain and bloating. He reported a weight loss of 3 stone over the last year through dieting, leaving him with a body mass index of 17. An abdominal examination revealed upper abdominal tenderness and distension. Blood tests showed a white cell count of 14.9×109/l but no other abnormalities.

An abdominal CT scan showed massive gastric and proximal duodenal dilation (figure 1), with compression of …

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