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Recurrent hematuria caused by nutcracker syndrome.

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Nutcracker syndrome, a rare condition causing left renal vein compression, was successfully treated in a young woman using open surgical transposition. This surgical approach resolved her symptoms and offers promising long-term results.

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Area of Science:

  • Urology
  • Vascular Surgery
  • Radiology

Background:

  • Nutcracker syndrome is a rare vascular condition characterized by the compression of the left renal vein.
  • Diagnosis often involves advanced imaging like computed tomography angiography.
  • Symptomatic presentation typically includes flank pain, hematuria, and proteinuria.

Observation:

  • A 26-year-old woman presented with left flank pain, hematuria, and proteinuria.
  • Renal ultrasound was inconclusive, but CT angiography revealed left renal vein compression between the superior mesenteric artery and aorta.
  • The patient underwent open surgical management with left renal vein transposition.

Findings:

  • The surgical transposition of the left renal vein to the inferior vena cava resulted in complete symptom resolution.
  • Postoperative care was uncomplicated, and the patient remained asymptomatic at 1-year follow-up.
  • Distal transposition of the left renal vein demonstrates good long-term efficacy.

Implications:

  • Open surgical transposition of the left renal vein is an effective treatment for Nutcracker syndrome.
  • This surgical option may offer a higher resolution rate and fewer post-surgery controls compared to endovascular treatments.
  • Further research with long-term surveillance is needed to definitively establish the optimal treatment strategy for Nutcracker syndrome due to its rarity.