Large varicocele revealing a nutcracker syndrome: A case report and literature review

Varicocele is a common condition that can cause male infertility and chronic scrotal pain. While most cases are idiopathic, secondary causes such as Nutcracker Syndrome (NCS) should be considered in atypical presentations, especially when hematuria is present.

A 22-year-old male presented with chronic left scrotal pain and intermittent hematuria. Physical examination and Doppler ultrasound confirmed a grade III left varicocele. Further imaging with CT angiography revealed NCS, characterized by left renal vein compression. Due to the mild nature of NCS symptoms and the patient's preference to avoid major surgery, only a varicocelectomy via the Ivanissevich technique was performed.

Secondary varicoceles require careful evaluation to rule out underlying causes such as NCS. Treatment varies based on symptom severity, with options ranging from conservative management to surgical intervention. In cases where NCS is mild, varicocelectomy alone can effectively relieve scrotal pain.

NCS should be considered in patients with varicocele and hematuria. While major interventions may be necessary in severe cases, isolated varicocelectomy can be an effective treatment for pain relief in selected patients.