Reviewer ’s report  
 
Title: Superior Mesenteric Artery Syndrome coexists with Nut cracker Syndrome in a female: a 
case report  
 
Version: 1 Date: 04 Oct 2018  
 
Reviewer: Jussi Karkkainen  
 
Reviewer's report:  
 
The authors report a case of bowel obstruction caused by SMA syndrome. The acute symptoms 
resolved with decompression by nasogastric tube. The CT images of this case report are  
illustrative and conclusive.  
 
 
It is unclear, whether the use of spasmolytic drugs was a predisposing factor for the acute 
symptoms. Was the patient still on that medication during hospitalisation? How often and for 
how long did she need the medication? Pl ease be more precise. Use small first letters when 
captioning generic drug names. Avoid abbreviations such as po tid, not everyone knows what 
this means.  
 
 
No need to abbreviate AA, AMD.  
 
 
0.37mm must be a mistake. I suggest using mm instead of cm throughout the manuscript.  
 
 
The weakness of this case report is that there is no follow -up. How long was the patient 
followed? Is she still symptomatic? Did she gain weight? If this is information is not available in 
the medical records, maybe a simple phone call to the patient would clarify this.  
 
 
The authors stress that this condition could be life -threatening and misdiagnosis is dangerous. 
What are the potential complications? Any reference in th e literature of potentially lethal 
complications?  
 
 
Please discuss any surgical treatment options with adequate references.  
 
 
 
 
 
 
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  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimburseme nts, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to al l of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my nam e will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website alon g with the authors' 
responses. I agree for my report to be made availabl e under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will no t be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Superior Mesenteric Artery Syndrome coexists with Nut cracker Syndrome in a female: a 
case report  
 
Version: 1 Date: 04 Oct 2018  
 
Reviewer: Jussi Karkkainen  
 
Reviewer's report:  
 
The authors report a case of bowel obstruction caused by SMA syndrome. The acute symptoms 
resolved with decompression by nasogastric tube. The CT images of this case report are  
illustrative and conclusive.  
 
 
It is unclear, whether the use of spasmolytic drugs was a predisposing factor for the acute 
symptoms. Was the patient still on that medication during hospitalisation? How often and for 
how long did she need the medication? Pl ease be more precise. Use small first letters when 
captioning generic drug names. Avoid abbreviations such as po tid, not everyone knows what 
this means.  
 
 
No need to abbreviate AA, AMD.  
 
 
0.37mm must be a mistake. I suggest using mm instead of cm throughout the manuscript.  
 
 
The weakness of this case report is that there is no follow -up. How long was the patient 
followed? Is she still symptomatic? Did she gain weight? If this is information is not available in 
the medical records, maybe a simple phone call to the patient would clarify this.  
 
 
The authors stress that this condition could be life -threatening and misdiagnosis is dangerous. 
What are the potential complications? Any reference in th e literature of potentially lethal 
complications?  
 
 
Please discuss any surgical treatment options with adequate references.  
 
 
 
 
 
 
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  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimburseme nts, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to al l of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my nam e will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website alon g with the authors' 
responses. I agree for my report to be made availabl e under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will no t be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Superior Mesenteric Artery Syndrome coexists with Nut cracker Syndrome in a female: a 
case report  
 
Version: 1 Date: 04 Oct 2018  
 
Reviewer: Jussi Karkkainen  
 
Reviewer's report:  
 
The authors report a case of bowel obstruction caused by SMA syndrome. The acute symptoms 
resolved with decompression by nasogastric tube. The CT images of this case report are  
illustrative and conclusive.  
 
 
It is unclear, whether the use of spasmolytic drugs was a predisposing factor for the acute 
symptoms. Was the patient still on that medication during hospitalisation? How often and for 
how long did she need the medication? Pl ease be more precise. Use small first letters when 
captioning generic drug names. Avoid abbreviations such as po tid, not everyone knows what 
this means.  
 
 
No need to abbreviate AA, AMD.  
 
 
0.37mm must be a mistake. I suggest using mm instead of cm throughout the manuscript.  
 
 
The weakness of this case report is that there is no follow -up. How long was the patient 
followed? Is she still symptomatic? Did she gain weight? If this is information is not available in 
the medical records, maybe a simple phone call to the patient would clarify this.  
 
 
The authors stress that this condition could be life -threatening and misdiagnosis is dangerous. 
What are the potential complications? Any reference in th e literature of potentially lethal 
complications?  
 
 
Please discuss any surgical treatment options with adequate references.  
 
 
 
 
 
 
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  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimburseme nts, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to al l of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my nam e will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website alon g with the authors' 
responses. I agree for my report to be made availabl e under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will no t be published.  
 
I agree to the open peer review policy of the journal  
assistant