The Nutcracker Syndrome as a Rare Cause of Chronic Abdominal Pain: A Case Report

Abstract

Introduction: Renal vein entrapment, named nutcracker phenomenon, is a contraction of renal vein between abdominal aorta and superior mesenteric artery. Patients can be asymptomatic or clinically manifested, called nutcracker syndrome. Proteinuria, hematuria, flank pain, varicocele in males and pelvic congestion in females are reported in such patients. Case Presentation: The current report presented an eight-year-old girl with microscopic hematuria and chronic abdominal pain along with short review of anatomy, pathophysiology, clinical significance and management of this syndrome. Conclusions:The nutcracker syndrome should be differentiated from unexplained chronic abdominal pain.

Nutcracker syndrome associated with celiacomesentric trunk anomaly: case report

“…4 Pournasiri referred to the disorder as NCS in 1972. 1 Hematuria is a common urinary abnormality with a prevalence of 0.5%-2.0% among school-age children. The prevalence of NCS in children with hematuria is unknown.…”

“…NCS presentation depends on the severity of the LRV hypertension which ends to the rupture of the thinwalled septum between the small veins and the collecting system in the renal fornix. 1,4 The diagnostic criteria of NCS have not been established yet, and there is no simple procedure for a definitive diagnosis at present. 7 Although it has been suggested that selective left renal venography is the standard procedure for the diagnosis of NCS, we did not use this technique in our patients because of its invasiveness and the burden of radiation that …”

“…1,2 When clinically manifested as proteinuria, hematuria, flank pain, pelvic congestion in women, and varicocele in men, it is called Nutcracker Syndrome (NCS). 2 It has been suggested that NCS is frequently a disease of tall children with lower body weight.…”

“…3 Patients' age can range from childhood to the seventh decade of life, but most patients become symptomatic in the second and third decades of their lives. 1,4 It is not a hereditary phenomenon, although coincidental cases in siblings have been described. 4 The diagnosis of the syndrome is often difficult, and the criteria for diagnosis and treatment are not well established.…”

“…3 This could be explained by increased BMI, which is an important factor in the changing renal hemodynamics, and due to the development of collateral veins that will reduce the LRV hypertension. 1,15 Despite there being no previous cases, some theoretical problems should be considered. As this is a rare association between CMT anomaly and NCS, the question of whether conservative management is applied to this variant is not known.…”