Work

Large varicocele revealing a nutcracker syndrome: A case report and literature review

Year: 2025

Type: article

Abstract: INTRODUCTION: Varicocele is a common condition that can cause male infertility and chronic scrotal pain. While most cases are idiopathic, secondary causes such as Nutcracker Syndrome (NCS) should be considered in atypical presentations, especially when hematuria is present. CASE PRESENTATION: A 22-year-old male presented with chronic left scrotal pain and intermittent hematuria. Physical examination and Doppler ultrasound confirmed a grade III left varicocele. Further imaging with CT angiography revealed NCS, characterized by left renal vein compression. Due to the mild nature of NCS symptoms and the patient's preference to avoid major surgery, only a varicocelectomy via the Ivanissevich technique was performed. DISCUSSION: Secondary varicoceles require careful evaluation to rule out underlying causes such as NCS. Treatment varies based on symptom severity, with options ranging from conservative management to surgical intervention. In cases where NCS is mild, varicocelectomy alone can effectively relieve scrotal pain. CONCLUSION: NCS should be considered in patients with varicocele and hematuria. While major interventions may be necessary in severe cases, isolated varicocelectomy can be an effective treatment for pain relief in selected patients.

Source: International Journal of Surgery Case Reports

DOI: 10.1016/j.ijscr.2025.111336

Authors: Salim Ouskri, Idriss Ziani, Adam El Aboudi, Ahmed Ibrahimi, Hachem El Sayegh, Yassine Nouini

Institution: Centre Hospitalier Ibn Sina

Language: English

Topic: Vascular anomalies and interventions

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090