A Unique Case of Wilkie Syndrome Reported in a Middle-Aged Female with Posterior Nutcracker Syndrome

Abstract

Nutcracker and Wilkie syndromes are rarely encountered, often being diagnosed incidentally during imaging investigations for other conditions. In this paper, we present the case of a 36-year-old patient with quasi-permanent symptoms characterized by epigastralgia, loss of appetite, early satiety, left lumbar colic pain, and dysuria. The clinical examination revealed a supple abdomen, sensitivity to palpation in the epigastrium and hypogastrium, frequent urination, and severe protein-caloric malnutrition body mass index (BMI = 15 kg/m2). Laboratory tests indicated a persistent microscopic hematuria without proteinuria and repeated urinary infections. Abdominal-pelvic ultrasound with Doppler showed a dilated left renal vein(LRV) up to 10 mm left of the paraaortic (Nutcracker syndrome) and duodenal obstruction with distension at this level, also confirmed by gastroduodenoscopy (EGD) (Wilkie syndrome). Abdominal-pelvic angioCT results indicated a malformation of the left renal vein dilated by compression in the aorto-mesenteric clamp and communicating with an aberrant left paravertebral and paraspinal network extending to L1 and L5 and a thrombosis of the left ovarian vein. The patient benefited from conservative treatment.