Two women, aged 39 and 54 years, had been experiencing episodes of lumbar and left flank pain for several years, with a gradual worsening of symptoms. In addition to the pain, they began to suffer from nausea, weight loss, and occasional fatigue. A CTA revealed dilatation of the left renal vein, which was compressed as it passed between the abdominal aorta and the superior mesenteric artery (SMA), confirming a diagnosis of nutcracker syndrome. Due to the presence of upper gastrointestinal symptoms suggestive of Wilkie syndrome, a decision was made to transpose the SMA. The procedure involved a median supraumbilical laparotomy performed under general anesthesia, followed by infrarenal reimplantation of the SMA, which resulted in a smooth postoperative recovery.