Left renal vein transposition is effective for posterior nutcracker syndrome

Area of Science:

• Urology
• Pediatric Surgery
• Vascular Anatomy

Background:

• Intermittent gross hematuria in children can stem from various causes, including vascular anomalies.
• A retroaortic left renal vein, where the vein passes behind the aorta, is a known anatomical variation.
• Compression of the left renal vein can lead to venous hypertension and subsequent bleeding.

Observation:

• An 8-year-old girl presented with a 3-year history of intermittent gross hematuria.
• Urethrocystoscopy revealed bloody efflux from the left ureteral orifice.
• Computerized tomography identified a retroaortic left renal vein compressed between the aorta and spine, with a groove on its anterior surface.

Findings:

• The anatomical abnormality, a compressed retroaortic left renal vein, was identified as the cause of the patient's hematuria.
• Surgical intervention involving transposition of the left renal vein to an anterior position relative to the aorta was performed.

Implications:

• Surgical correction of a compressed retroaortic left renal vein can effectively resolve hematuria in pediatric patients.
• This case highlights the importance of considering vascular anomalies in the differential diagnosis of pediatric hematuria.
• Vascular transposition surgery offers a viable treatment option for symptomatic renal vein compression.