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Updated: Jan 5, 2026

Multimodality Diagnosis of Mesenteric Ischemia

Multimodality Diagnosis of Mesenteric Ischemia

Published on: July 21, 2023

Nutcracker syndrome complicated with intestinal malrotation.

Yosuke Nishio¹, Yoshihiko Kawano², Shinya Hara²

¹Pediatrics, TOYOTA Memorial Hospital, Toyota, Aichi, Japan y.nishio1989@gmail.com.

BMJ Case Reports

|October 13, 2019

Summary

Nutcracker syndrome (NCS), a left renal vein compression, can be linked to intestinal malrotation in children. Surgical correction of malrotation resolved hematuria in a pediatric NCS case, suggesting a potential cause.

Keywords:

gastrointestinal surgery haematuria paediatrics

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Area of Science:

Pediatric Nephrology
Vascular Surgery
Gastroenterology

Background:

Nutcracker syndrome (NCS) involves left renal vein (LRV) compression between the superior mesenteric artery (SMA) and aorta, potentially leading to chronic kidney disease.
While often idiopathic in children, NCS can stem from pathologies like retroperitoneal tumors.
No prior reports exist on pediatric NCS cases complicated by intestinal malrotation.

Observation:

A 12-year-old girl presented with intestinal malrotation complicated by Nutcracker syndrome.
This is the first reported pediatric case of NCS associated with intestinal malrotation.

Findings:

Surgical correction of intestinal malrotation led to the resolution of hematuria in the patient.
Intestinal malrotation, particularly with associated weight loss, is proposed as a potential underlying etiology for NCS.

Implications:

Clinicians should consider intestinal malrotation in pediatric patients diagnosed with NCS, especially when gastrointestinal symptoms are present.
This case highlights the importance of investigating gastrointestinal causes for NCS in children.