Work

Breaking the Nutcracker: a case-based review of diagnosis and surgical treatment

Year: 2025

Type: article

Abstract: Nutcracker syndrome is a rare condition caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. This results in increased venous pressure, leading to haematuria, flank pain, and pelvic discomfort, particularly in individuals with low body mass index. Diagnosis is often challenging due to nonspecific symptoms and overlap with other pelvic disorders. We report a case of a 49-year-old woman with persistent left flank pain, dysmenorrhea, and recurrent vaginal bleeding. Imaging confirmed compression of the left renal vein. A conservative approach with nutritional support was initially attempted, but due to ongoing symptoms, the patient underwent surgical transposition of the vein with patch angioplasty using bovine pericardium. This case underscores the need to consider Nutcracker syndrome in patients with unexplained haematuria and flank pain, especially in underweight women. We also review current diagnostic tools and treatment options for this uncommon vascular condition.

Source: Journal of Surgical Case Reports

DOI: 10.1093/jscr/rjaf920

Authors: Roberto Cunha, Francisco Basilio, Ricardo Gouveia, Vitor Martins, Alexandra Canedo

Institutions: Hospital do Divino Espírito Santo, Unidade Local de Saúde Gaia/Espinho

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: $1,000