Review for 10.1186/s12876-019-0932-1 (2019)

Reviewer ’s report  
 
Title: Superior Mesenteric Artery Syndrome coexists with Nut cracker Syndrome in a female: a 
case report  
 
Version: 1 Date: 15 Oct 2018  
 
Reviewer: Silvío Mazziotti  
 
Reviewer's report:  
 
Although already des cribed in literature, SMA and Nutcracker phenomenon are rare pathological 
conditions that sometimes can coexist. Radiologists and clinicians should always be aware of 
these conditions in young patients with an history of weight loss and abdominal pain.  
 
 
The case is interesting and well written.  
 
 
However, some pints need to be clarified:  
 
- In literature the SMA syndrome is also known as "Wilkie's syndrome". I suggest to add this 
denomination too.  
 
- The authors refer to "Nutcracker phenomenon" and not to "Nut cracker syndrome". Indeed, it is 
true that the patients did not suffer from hematuria, but anyway a left flank pain was detected at 
the abdominal examination.  
 
 
Moreover, two different phenotypes of Nutcracker phenomenon/syndrome exist (anterior and 
posteri or). 
 
 
I would like that the authors could be clearer in the text about these two points.  
 
- The authors report that the upper gastrointestinal double -contrast radiograph was performed 
after the CT -scan. Considering the age and the gender of the patient, was  it really necessary to 
achieve a diagnosis? If yes, was that the right timing for its performance (after the CT -scan)?  
 
 
In this sense, I would like that the authors could briefly describe in discussion the different 
imaging modalities available (especiall y for the "radiation -free" alternatives), the indications and 
the principle findings for each one.  
 
Moreover, I would suggest  these articles:  
 
o Neri, S. , Signorelli, S. S., Mondati, E. , Pulvirenti, D. , Campanile, E. , Di Pino, L. , Scuderi, 
M. , Gius tolisi, N. , Di Prima, P. , Mauceri, B. , Abate, G. , Cilio, D. , Misseri, M. Scuderi, R. 
(2005), Ultrasound imaging in diagnosis of superior mesenteric artery syndrome. Journal of 
Internal Medicine, 257: 346 -351. doi:10.1111/j.1365 -2796.2005.01456.x  
 
o Cicero G, D'Angelo T, Bottari A, et al. Superior Mesenteric Artery Syndrome in Patients with 
Crohn's Disease: A Description of 2 Cases Studied with a Novel Magnetic Resonance 
Enterography (MRE) Procedure. The American Journal of Case Reports. 2018;19:431 -437. 
doi:10.12659/AJCR.908273.  
 
- In my opinion, the graphical overlay pointers of Fig. 1 c are a bit confusing. I think they should 
be put within the structure that they are labeling. Maybe a "zoomed" detail of the image could be 
easily understandable for th e reader.  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comment s to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess   
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional st atistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language  in the manuscript:  
 
Needs some language cor rections before being published  
 
 
 
 
Declaration of competing interests  
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