A Tough Nut to Crack: Chronic Fatigue Syndrome and Abdominal Pain Attributed to Nutcracker Syndrome

Abstract

Nutcracker phenomenon refers to entrapment of the left renal vein between the superior mesenteric artery and aorta. This can result in elevated left renal vein pressure and reduced renal perfusion. Nutcracker syndrome, which refers to symptoms associated with the above phenomenon, usually presents with acute onset hematuria and abdominal pain, but more rarely, may present as chronic fatigue syndrome. Here, we present a case of a 24-year-old male with a seven-year history of chronic fatigue syndrome, which was subsequently found to have imaging characteristics consistent with nutcracker phenomenon. His fatigue markedly improved after insertion of a left renal vein stent.