Tit for Tat: A Case Series of Hollow Viscus and Vascular Compressions

Abstract

Background Abdominopelvic vascular and hollow viscus compression syndromes present unique challenges in radiological diagnosis, often requiring thorough exclusion of other pathologies. Recognizing these rare syndromes is essential for accurate differential diagnosis and timely treatment, reducing morbidity and mortality. This case series aims to share notable experiences in identifying unusual compression syndromes through radiological findings.

Case Reports Case 1: A 22-year-old male presented with postprandial epigastric discomfort and reflux, which was diagnosed as duodenal compression due to the mid portion of the third segment of the duodenum being compressed between the superior mesenteric vein and the aorta. Case 2: A 47-year-old male with left loin pain revealed hydroureteronephrosis caused by smooth narrowing/kinking at the level of the fourth lumbar vertebra, leading to obstruction and renal dysfunction. Case 3: A 15-year-old female with left lower limb swelling and pain was diagnosed with venous thrombosis in the left common iliac, external iliac, and common femoral veins due to giant fecal impaction.

Discussion These cases underscore the significance of recognizing vascular compression syndromes that mimic common clinical conditions. Case 1 highlights the rare compression of the duodenum, which may be mistaken for gastroesophageal reflux disease (GERD). Case 2 illustrates how vascular kinking can obstruct the urinary tract and cause hydroureteronephrosis. Case 3 emphasizes the role of fecal impaction in leading to venous thrombosis, a potentially overlooked complication. Prompt imaging and differential diagnosis are critical for proper management.

Conclusion These cases provide valuable insights into the recognition and management of abdominopelvic vascular and hollow viscus compression syndromes. Understanding these rare conditions allows for accurate diagnosis, timely treatment, and improved patient outcomes. The findings contribute to the body of knowledge, aiding healthcare professionals in managing such complex clinical presentations.

Keywords

hollow viscus compressions - SMA syndrome - SMV syndrome - testicular vein syndrome - vascular compressions

Publikationsverlauf

Artikel online veröffentlicht:
20. Januar 2025

• References

• 1 Gozzo C, Giambelluca D, Cannella R. et al. CT imaging findings of abdominopelvic vascular compression syndromes: what the radiologist needs to know. Insights Imaging 2020; 11 (01) 48
• 2 Shin J, Shin PJ, Bartolotta RJ. SMA-like syndrome with variant mesenteric venous anatomy. Clin Imaging 2018; 48: 86-89
• 3 Hecht J, Gruhn C, Schoenberg MH. Vena-mesenterica-superior-Syndrom–eine Duodenalstenose, bedingt durch eine atypisch verlaufende V. mesenterica superior. Chirurg 2001; 72 (02) 186-189
• 4 Ahmad KS, Alenazi NA, Essa MS, Alrushdan MS, Al-Shoaib AM. Laparoscopic duodenojejunostomy for superior mesenteric vein syndrome associated with nutcracker phenomenon: the first case report. Am J Case Rep 2019; 20: 1108-1113
• 5 Dross PE, Molavi S, Chan A, Latshaw R, Chhabra P. Unusual etiologies for vascular duodenal compression mimicking the superior mesenteric artery (SMA) syndrome: the SMA-like syndrome. J Gastrointest Abdomin Radiol 2019; 2: 140-146
• 6 Arvind NK, Singh O, Gupta SS. Testicular vein syndrome and its treatment with a laparoscopic approach. JSLS 2011; 15 (04) 580-584
• 7 Meyer JI, Wilbur AC, Lichtenberg R. Ureteric obstruction by the right testicular vein: CT diagnosis. Urol Radiol 1992; 13 (04) 233-236
• 8 Hamidi H. Testicular vein syndrome: review of the literature and recent case report. The. Egypt J Radiol Nucl Med 2017; 48: 1125-1130
• 9 Rajagopal A, Martin J. Giant fecaloma with idiopathic sigmoid megacolon: report of a case and review of the literature. Dis Colon Rectum 2002; 45 (06) 833-835
• 10 Mushtaq M, Shah MA, Malik AA, Wani KA, Thakur N. Q Parray F. Giant fecaloma causing small bowel obstruction: case report and review of the literature. Bull Emerg Trauma 2015; 3 (02) 70-72
• 11 Park JS, Park T-J, Hwa JS, Seo J-H, Park C-H, Youn H-S. Acute urinary retention in a 47-month-old girl caused by the giant fecaloma. Pediatr Gastroenterol Hepatol Nutr 2013; 16 (03) 200-205
• 12 Yucel AF, Akdogan RA, Gucer H. A giant abdominal mass: fecaloma. Clin Gastroenterol Hepatol 2012; 10 (02) e9-e10
• 13 Caiazzo P, De Martino C, Del Vecchio G. et al. Megacolon for a giant faecaloma with unlucky outcome: case report and review of the literature. Ann Ital Chir 2013; 84 (03) 319-322
• 14 Culler K, Eiswirth P, Donaldson J, Green J, Rajeswaran S. Deep vein thrombosis due to fecal impaction. J Pediatr Hematol Oncol 2020; 42 (08) e772-e774
• 15 Obokhare I. Fecal impaction: a cause for concern?. Clin Colon Rectal Surg 2012; 25 (01) 53-58
• 16 Seth AK, Gupta MK, Bansal RK, Verma RK, Kaur G. Colonoscopic instillation of Coca-Cola for evacuation of large fecaloma: a report of two cases and review of literature. J Health Allied Sciences NU 2022; 12: 98-100