Unusual coexistence of vascular compression syndromes: Nutcracker, Dunbar, and May–Thurner syndromes

Hèla Ben Jmaâ, Zied Ben Ayed, Faten Dhouib, Hafedh Daly, Rahma Kallel, Imed Frikha

Abstract

Vascular compression syndromes represent a group of rare conditions caused by extrinsic compression of veins or arteries by surrounding anatomical structures. These disorders are often underdiagnosed due to nonspecific symptoms, and the coexistence of multiple syndromes in a single patient is extremely rare. We report an 18-year-old woman with no past medical history who presented with intermittent abdominal and lumbar pain and progressive weight loss, without haematuria. Initial ultrasonography and contrast-enhanced computed tomography revealed the coexistence of Nutcracker, Dunbar (median arcuate ligament), and May–Thurner syndromes. The patient underwent open surgical management via median laparotomy, involving median arcuate ligament section to relieve coeliac trunk compression, transposition of the left renal vein, and decompression of the left common iliac vein by mobilisation of the right common iliac artery. The postoperative course was uneventful, with significant symptom relief and favourable long-term outcomes. This case highlights the diagnostic challenges and therapeutic complexity associated with combined vascular compression syndromes, emphasising the importance of a multidisciplinary surgical approach.