Abdominal Pain of Vascular Origin

Denham, Stephanie LeeAnn Wilson; Hester, Felix A.; Weber, Therese M.

doi:10.1097/ruq.0b013e3182a2de32

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…Furthermore, although compression of the LRV is a common radiological finding, the frequency with which the compression actually causes pathological symptoms remains unclear. It is believed, however, that the manifestation of pathological symptoms constitutes a rare disorder [ 81 , 84 , 98 ].…”

Section: Discussionmentioning

confidence: 99%

Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature

Heidbreder

2018

J Med Case Reports

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BackgroundThe duodenum and the left renal vein occupy the vascular angle made by the superior mesenteric artery and the aorta. When the angle becomes too acute, compression of either structure can occur. Each type of compression is associated with specific clinical symptoms that constitute a rare disorder. If clinical symptoms are mild, conservative treatment is implemented. However, surgery is often the only solution that can improve quality of life and/or avoid life-threatening complications. This report describes a case of a patient with both types of aortomesenteric compression that required two separate surgeries to alleviate all symptoms.Case presentationA 20-year-old white woman presented to the Emergency Room complaining of sudden onset severe left flank and lower left quadrant abdominal pain, nausea, and vomiting. A clinical work-up revealed elevated white blood cells and hematuria. She was discharged with a diagnosis of urinary tract infection. Symptoms continued to worsen over the subsequent 2 months. Repeated and extensive clinical work-ups failed to suggest evidence of serious pathology. Ultimately, an endoscopy revealed obstruction of her duodenum, and barium swallow identified compression by the superior mesenteric artery, leading to the diagnosis of superior mesenteric artery syndrome. She underwent a Roux-en-Y duodenojejunostomy. Six weeks later she continued to have severe left-sided pain and intermittent hematuria. Venography revealed compression of the left renal vein, extensive pelvic varices, and significant engorgement of her left ovarian vein. A diagnosis of nutcracker syndrome was made and a left renal vein transposition was performed. Significant improvement was seen after 8 weeks.ConclusionsThe disorders associated with aortomesenteric compression can lead to serious symptoms and sometimes death. Diagnosis is challenging not only because of the lack of awareness of these rare disorders, but also because they are associated with symptoms that are similar to those seen in less serious diseases. Guidance for health care professionals with respect to relevant radiological and clinical markers needs to be reconsidered in order to clarify the etiology of the diseases and create better diagnostic protocols.

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Section: Discussionmentioning

confidence: 99%

Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature

Heidbreder

2018

J Med Case Reports

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“…Pelvic congestion resulting in abdominal pain, flank pain, back pain and varicocele is observed in patients with NCS (1,14,15). Collaterals formation could become a cause of pelvic congestion (3,16).…”

Section: Discussionmentioning

confidence: 99%

“…Nutcracker phenomenon (NCP) is a rare vascular variation which is caused by contraction of the left renal vein, usually between the superior mesenteric artery (SMA) and the aorta. The nutcracker syndrome (NCS) results in some symptoms that range from mild proteinuria or asymptomatic microscopic hematuria to severe symptoms duo to pelvic congestion (1) or nephrotic range proteinuria (2). Most patients become symptomatic in the second and third decades of their lives (3).…”

Section: Introductionmentioning

confidence: 99%

The Nutcracker Syndrome as a Rare Cause of Chronic Abdominal Pain: A Case Report

Pournasiri

2016

J Compr Ped

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Introduction: Renal vein entrapment, named nutcracker phenomenon, is a contraction of renal vein between abdominal aorta and superior mesenteric artery. Patients can be asymptomatic or clinically manifested, called nutcracker syndrome. Proteinuria, hematuria, flank pain, varicocele in males and pelvic congestion in females are reported in such patients. Case Presentation: The current report presented an eight-year-old girl with microscopic hematuria and chronic abdominal pain along with short review of anatomy, pathophysiology, clinical significance and management of this syndrome. Conclusions:The nutcracker syndrome should be differentiated from unexplained chronic abdominal pain.

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Imaging of Vascular Abdominal Pain

Mucelli

2019

Pain Imaging

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Abdominal Pain of Vascular Origin

Cited by 4 publications

References 5 publications

Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature

Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature

The Nutcracker Syndrome as a Rare Cause of Chronic Abdominal Pain: A Case Report

Imaging of Vascular Abdominal Pain

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