Nutcracker Syndrome as an Unusual Cause of Postprandial Pain

Maloni, Krystal; Calligaro, Keith D.; Lipshutz, William; Vani, Kunal; Troutman, Douglas A.; Dougherty, Matthew J.

doi:10.1177/1538574419896721

Cited by 4 publications

(5 citation statements)

References 9 publications

(12 reference statements)

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“…Although, variations in anatomy may exist and the condition may also go undiagnosed and untreated 14 . This syndrome causes venous congestion and various other symptoms 15 by restricting flow via the LRV 13 . “Nutcracker phenomenon” defines aorto-mesenteric compression of the LRV while asymptomatic, whereas ‘Nutcracker syndrome’ identifies individuals with distinctive symptoms linked to Nutcracker anatomical morphology 13 .…”

Section: Discussionmentioning

confidence: 99%

“…Varicocele or pelvic congestion syndrome may result from venous congestion adjacent to LRV compression affecting left gonadal vein. Infertility, abdominal varicose veins, vaginal wall, buttocks or upper thighs, dyspareunia, dysmenorrhoea, orthostatic hypotension, tiredness and stomach discomfort are some additional symptoms seen in patients experiencing this syndrome 13 , 15 , 20 .…”

Section: Discussionmentioning

confidence: 99%

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Anterior Nutcracker syndrome in a young male patient: a case report and review of literature

Hamdan,

Homsy,

Rashid

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction and importance: The left renal vein (LRV) is affected by a venous compression syndrome called Nutcracker syndrome (NCS). This syndrome is characterized by extrinsic compression of the LRV, which usually occurs between aorta and superior mesenteric artery. It is a rare and under-diagnosed condition, more prevalent in females and that, if left untreated, can lead to severe problems. There are no clear guidelines regarding management. Therefore, the authors report this rare case and its symptoms in male patient and they display current management options. Case presentation: NCS was observed during computer tomography in a male patient presented with persistent left flank pain and associated haematuria. Ultrasound for left scrotum demonstrated left moderate-sized varicocele. The left varicocele testis unit was 1.6 mm and during the Valsalva manoeuvre in the supine position the testis unit was 2 mm. LRV compression between abdominal aorta and superior mesenteric artery was identified by computer tomography imaging and therefore, diagnosis of NCS was confirmed. Clinical discussion: The actual prevalence is unclear, and incidence rates have been observed to fluctuate among age group and more prevalent in women. Main symptoms include haematuria, left flank discomfort, varicocele in men, proteinuria and anaemia. Depending on severity of symptoms, management might range from conservative care to surgery. Conclusion: This treatment strategy was effective in reducing the symptoms of the patients. In young patients, conservative treatment is advised for a fair amount of time. However, more studies on how much the authors should wait before considering surgery is important.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anterior Nutcracker syndrome in a young male patient: a case report and review of literature

Hamdan,

Homsy,

Rashid

et al. 2023

Annals of Medicine &Amp; Surgery

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“…Left abdominal/flank pain, hematuria, and proteinuria are the most common symptoms in NCS. The left flank/abdominal pain or pelvic pain as the only manifestation of NCS is comparatively rare and can often be alleviated [6][7][8][9][10] (Table 1). The pain is related to LRV hypertension or pelvic congestion caused by NCS.…”

Section: Discussionmentioning

confidence: 99%

Successful Resolution of Nutcracker Syndrome with 3D Printed PEEK Extravascular Stent in an Adolescent Boy

Da-li¹

2022

acc

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Three-dimensional printed polyetheretherketone (PEEK) extravascular stent was applied to treat a 14-year-old boy with nutcracker syndrome. Digital subtraction angiography revealed a segment of the left renal vein (LRV) with reduced contrast filling immediately before its inflow into the inferior vena cava, and high-pressure gradient. The three-dimensional reconstruction model demonstrated that the LRV and the duodenum were contracted at the aortomesenteric angle, resulting in LRV compression from the abnormal high-level duodenal compartment. When duodenum courses between the abdominal aorta and superior mesenteric artery (duodenal interposition), the LRV entrapment occurs even at <90 aortomesenteric degrees. Three-dimensional printed PEEK extravascular stent was chosen to elevate the superior mesenteric artery and lower the duodenum position, thus relieving LRV compression. This extravascular application has significant advantages over open surgery, endovascular stenting and artificial vessel procedures with expanded polytetrafluoroethylene. It provides better cellular vitality by ensuring soft tissue proliferation. By reducing external acceleration and centrifugal force, a three-dimensional printed PEEK extravascular stent reduces adverse side effects. Such a stent has a distinctive personalized design, good stiffness, and durability that allows blood vessel growth, preventing stent migration and thrombosis. Therefore, it is suitable for both adult and pediatric patients. According to the abdominal ultrasound and multi-slice computed tomography scan, the postoperative follow-up results were satisfactory one year after surgery. The patient felt well, the blood flow in the LRV was not obstructed, and the blood flow velocity was average. The external stent was in place.

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“…Patients with NCS may present with various symptoms, with the most common symptoms including hematuria, left flank pain, varicocele in males, proteinuria, and anemia [6]. Patients may also present with abdominal pain, dysmenorrhea, dyspareunia, orthostatic hypotension, fatigue, infertility, and varicose veins of the abdomen, vaginal wall, buttocks, or upper thighs [2,7,8]. In rare cases, autonomic dysfunction symptoms, such as hypotension, tachycardia, and syncope, have been reported [9].…”

Section: Introductionmentioning

confidence: 99%

Nutcracker Phenomenon: A Rare Incidental Finding

AlQefari

Alduraibi

Almansour

et al. 2022

Cureus

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The nutcracker phenomenon, or left renal vein (LRV) entrapment syndrome, occurs when there is compression of the LRV, mostly between the abdominal aorta and the superior mesenteric artery. Patients with nutcracker syndrome (NCS) may present with various symptoms, with the most common being hematuria, left flank pain, varicocele in males, proteinuria, and anemia. Our 22-year-old male patient presented with abdominal pain without hematuria. Insidiously, we made the diagnosis of NCS with this unusual presentation. Some studies have proposed a relationship between rapid weight loss in a short period of time and the appearance of NCS. We recommend that healthcare providers suspect NCS in patients who present with abrupt severe abdominal discomfort, particularly in situations that coincide with rapid weight loss for an unknown reason.

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Nutcracker Syndrome as an Unusual Cause of Postprandial Pain

Cited by 4 publications

References 9 publications

Anterior Nutcracker syndrome in a young male patient: a case report and review of literature

Anterior Nutcracker syndrome in a young male patient: a case report and review of literature

Successful Resolution of Nutcracker Syndrome with 3D Printed PEEK Extravascular Stent in an Adolescent Boy

Nutcracker Phenomenon: A Rare Incidental Finding

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