Nutcracker syndrome with different clinical presentations in a young male population

Abstract

SUMMARYThe nutcracker syndrome (NCS) depends on mesoaortic compression of the left renal vein. It has different clinical entities. This study aimed to examine different clinical aspects of NCS.This was a retrospective and descriptively designed study. The patients with abdominal pain, flank pain, or scrotal pain admitted to the Urology and General Surgery outpatient clinic between January 2014 and May 2016 were reviewed. All data were examined descriptively. Urologic and general surgical examinations were performed individually by a urologist and a general surgeon. The abdominal ultrasonography and computed tomography findings, blood pressure, white blood cell count, bilirubin tests, and urine tests were recorded.Patients with inconsistent diagnostic data or missing outcomes were excluded. Five patients were diagnosed with NCS on scanning 134 patients. The mean age was 24 years (20-33 years). The first patient had left lower quadrant pain. The second patient also had left lower quadrant pain with microscopic hematuria and a mild increase in the total bilirubin level (1.84 mg/dL). The third patient presented left testicular pain and hypertension (160/100 mm Hg). Consequently, left side varicocele was found on physical examination and Doppler ultrasound. The fourth patient had leukocytosis (11,900), a mild increase in total bilirubin level (1.73 mg/dL), and left and right lower quadrant pain.The radiological and laboratory entities must be taken into consideration with clinical findings for correct diagnosis because NCS may have different symptoms.