Where There’s a Will, There Can Be a Wrong and a Right Way!

Dianne is a Chief resident in neurosurgery who after a seven-year courtship decides to marry. She realizes that a window of time exists between when she finishes her residency and her fellowship starts, only a month later. Her plan to wear her grandmother’s bridal gown is in jeopardy, however, because during her residency she gained considerable weight and is unlikely to fit into a size 6 gown. Thinking where there’s a will, there’s a way, Dianne goes on an extreme weight reduction plan along with an exhaustive exercise regime and the new pounds begin to melt away. A few days before her wedding, Dianne begins to experience urinary frequency and urgency and lower back pain. She recognizes that something is amiss and postpones her wedding.

Question: If the following vessel is constricted by the “nutcracker effect”, back-up of venous return is most likely to occur at which of the following?

A.IVC

B.Inferior mesenteric a.

C.Left ovarian vein

D.Portal vein

E.Superior mesenteric a.