Transperitoneal Laparoscopic Left Gonadal Vein Ligation Can Be the Right Treatment Option for Pelvic Congestion Symptoms Secondary to Nutcracker Syndrome

Vascular ◽  
2007 ◽  
Vol 15 (4) ◽  
pp. 238-240 ◽  
Author(s):  
Alistair Rogers ◽  
Andrew Beech ◽  
Bruce Braithwaite
Keyword(s):  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Nutcracker Syndrome ◽  
Venous Flow ◽  
Nutcracker Phenomenon ◽  
Gonadal Vein ◽  
Multiparous Women ◽  
The Right ◽  
Laparoscopic Sterilization ◽  
Pelvic Congestion

The nutcracker phenomenon refers to compression of the left renal vein at the origin of the superior mesenteric artery and is often underdiagnosed. This can cause symptoms of pelvic venous congestion with retrograde venous flow and a dilated gonadal vein. Here we describe a case in a 39-year-old female, who following imaging investigations to confirm the diagnosis, underwent transperitoneal laparoscopic ligation of the left gonadal vein. Laparoscopic sterilization was also performed with the aid of the gynecologists. Multiparous women, who are more likely to develop pelvic congestion symptoms, more commonly request sterilization and thus we propose that a dual laparoscopic procedure in these cases could be the treatment of choice.

scholarly journals Inverted Nutcracker Syndrome: A Case of Persistent Hematuria and Pain in the Presence of a Left-Sided Inferior Vena Cava

2011 ◽  
Vol 11 ◽  
pp. 1031-1035 ◽  
Author(s):  
Obi Ekwenna ◽  
Michael A. Gorin ◽  
Miguel Castellan ◽  
Victor Casillas ◽  
Gaetano Ciancio
Keyword(s):  
Inferior Vena Cava ◽  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Inferior Vena ◽  
Left Renal Vein ◽  
Left Kidney ◽  
Vena Cava ◽  
Nutcracker Syndrome ◽  
The Right

Nutcracker syndrome is described as the symptomatic compression of left renal vein between the aorta and the superior mesenteric artery, resulting in outflow congestion of the left kidney. We present the case of a 51-year-old male with a left-sided inferior vena cava, resulting in compression of the right renal vein by the superior mesenteric artery. Secondary to this anatomic anomaly, the patient experienced a many-year history of flank pain and intermittent gross hematuria. We have termed this unusual anatomic finding and its associated symptoms as the “inverted nutcracker syndrome”, and describe its successful management with nephrectomy and autotransplantation.

Anterior Nutcracker Syndrome with Left Gonadal Vein Varicosities on Multiphasic Computed Tomography: An Unexpected Cause of Pyeloureteral Junction Obstruction

2015 ◽  
Vol 97 (4) ◽  
pp. 482-484
Author(s):  
Maddalena Di Carlo ◽  
Caterina Gaudiano ◽  
Fiorenza Busato ◽  
Simone Pucci ◽  
Riccardo Schiavina ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Nutcracker Syndrome ◽  
Left Flank ◽  
Gonadal Vein ◽  
Renal Hilum ◽  
Left Flank Pain ◽  
Uncommon Complication

The anterior nutcracker syndrome is defined by the compression of the left renal vein between the aorta and superior mesenteric artery, usually related to the occurrence of hematuria. We report the case of an uncommon complication of the nutcracker syndrome. A 75-year-old woman was referred to our institution for left flank pain without hematuria. Multiphasic computer tomography urography showed a condition of left renal vein entrapment between the aorta and superior mesenteric artery with the development of left gonadal vein varicosities at the level of the renal hilum; a pyeloureteral junction compression with dilation of the pyelocalyceal system coexisted. To our knowledge, this is the first report of the association between nutcracker syndrome and pyeloureteral junction obstruction.

The desperate plea of women with the nutcracker syndrome

Phlebologie ◽  
2010 ◽  
Vol 39 (02) ◽  
pp. 104-111
Author(s):  
J. L. Villavicencio
Keyword(s):  
Renal Vein ◽  
Imaging Techniques ◽  
Left Renal Vein ◽  
Diagnostic Tools ◽  
Nutcracker Syndrome ◽  
Treatment Techniques ◽  
Children And Young Adults ◽  
Good Number ◽  
Pelvic Congestion

Summary Objective: To increase awareness on the severe impact of the nutcracker syndrome in women with undiagnosed disease. Patients and methods: We reviewed the medical literature and analyzed six representative series with 73 patients with nutcracker syndrome. Women with left flank pain, dyspareunia, dysuria, dysmenorrhea, micro- or macrohaematuria and pelvic congestion symptoms, should be carefully investigated for evidence of meso aortic left renal vein compression. A good number of our colleagues do not believe in the existence of the nutcracker syndrome and send these patients in a long pilgrimage in search of someone who can help them to get relief to their pain. New and improved imaging techniques can assist in the diagnosis but retrograde reno-gonadal phlebography and renocaval gradient are the most reliable diagnostic tools. Results: Among an assortment of treatment techniques, renal vein transposition and endovenous stenting were the two most commonly used procedures. There are no long term studies on renal vein stenting in children and young adults. Its use in these cases should be carefully considered. The nutcracker syndrome may present with pelvic congestion symptoms and its diagnosis missed. The patient's age, severity of symptoms and haemo dynamic renal studies should guide the treatment. Conclusion: An increased awareness of the existence of the nutcracker syndrome may prevent many unfortunate undiagnosed women from spending many months and often years of suffering.

scholarly journals Nutcracker Syndrome: A Rare Cause of Hematuria

2006 ◽  
Vol 6 ◽  
pp. 745-746 ◽  
Author(s):  
Emmanuel C. Gorospe ◽  
Michael O. Aigbe
Keyword(s):  
Superior Mesenteric Artery ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Nutcracker Syndrome ◽  
Renal Veins ◽  
Collecting System

Nutcracker syndrome is the compression of the left renal vein between the aorta and superior mesenteric artery. It is a rare cause of hematuria which results from the rupture of congested renal veins into the collecting system.

scholarly journals Imaging of Type I Retroaortic Left Renal Vein & Nutcracker Syndrome

2022 ◽  
Author(s):  
Giovanni Fontanella ◽  
Simona Borrelli ◽  
Umberto Dello Iacono ◽  
Barbara Brogna
Keyword(s):  
Left Renal Vein ◽  
Venous Hypertension ◽  
Point Of View ◽  
Type I ◽  
Nutcracker Syndrome ◽  
Renal Veins ◽  
Gross Hematuria ◽  
Renal Venous Hypertension ◽  
Symptoms And Signs ◽  
Pelvic Congestion

Retroaortic left renal veins are an often overlooked, but no so rare anatomic anomaly that might cause a few aspecific symptoms and signs, especially flank or inguinal pain, microscopic or even gross hematuria; in the vast majority of cases it is, thought, totally asymptomatic. The nutcracker syndrome that might arise in the case of RLRV is mainly due to the re- duced space between aorta and the vertebral body and the consequent compression on the venal rein; this might in turn cause upstream hypertension, hematuria, varicocele, pain. The compression of RLRV leads to hematuria because of renal venous hypertension, consequent left renal congestion. This upstream venous congestion might result, in some cases, in left-sided varicocele in men and pelvic congestion syndrome in women. From a radiologic point of view, the presence of RLRV and the precise reporting its subtypes is mandatory.

scholarly journals Chronic Pelvic Pain and Hematuria Associated with Posterior Nutcracker Syndrome

2020 ◽  
Vol 06 (11) ◽  
Author(s):  
Dr. L. Belkouchi ◽  
Keyword(s):  
Superior Mesenteric Artery ◽  
Pelvic Pain ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Chronic Pelvic Pain ◽  
Anatomical Variation ◽  
Left Renal Vein ◽  
Young Patients ◽  
Nutcracker Syndrome ◽  
Posterior Nutcracker Syndrome

The nutcracker syndrome is a rare syndrome in which the left renal vein is compressed between the aorta and the superior mesenteric artery or even more rarely between the aorta and vertebral body, in case of an anatomical variation of the left renal vein. It is more likely discovered within young patients presenting pelvic pain, hematuria, or varicocele. Treatments vary from conservative, to surgical or endovascular. Here we present the case of a young patient with chronic pelvic pain and hematuria, diagnosed as a posterior nutcracker syndrome.

scholarly journals Anatomical study of the renal veins observed during 342 living-donor nephrectomies

1997 ◽  
Vol 115 (3) ◽  
pp. 1456-1459 ◽  
Author(s):  
José Carlos Costa Baptista-Silva ◽  
Marcos José Veríssimo ◽  
Marcos Joaquim Castro ◽  
André Luiz Guimarães Câmara ◽  
José Osmar Medina Pestana
Keyword(s):  
Renal Vein ◽  
Living Donor ◽  
Inferior Vena ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Renal Veins ◽  
Gonadal Vein ◽  
The Right

The anatomical variations of renal veins observed during 342 nephrectomies in living donors are described, 311 cases on the left side and 31 on the right. The following anatomy of the renocava veins was observed: 1. On the left side the renal vein was always unique (311/311) and had two tributaries (suprarenal and gonadal veins) in 100 per cent and one or more renolumbar veins in 65.27 per cent, encircling the aorta in 1.07 per cent, was retroaortic in 1.4 per cent; and the inferior vena cava was double in 0.64 per cent; B- on the right side the renal vein was double in 29 per cent (9/31) and had only one tributary (gonadal vein) in one case, for 3.22 per cent (1/ 31); three or more renal veins in 9.7 per cent (3/31). We concluded that the left renal vein is always unique, presenting variations principally in its tributaries and trajectory. On the right side, the renal vein was double or triple in 38.79 per cent

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