Heavy uterine bleeding as an unusual presentation of posterior nutcracker syndrome in an adolescent

Posterior nutcracker syndrome results from compression of the left renal vein between the aorta and the spine, secondary to an anomalous and rare anatomical location of the vein. The typical clinical presentation includes hematuria and chronic pain. We present the case of a 14-year-old female patient with a 20-day history of heavy uterine bleeding requiring a red blood cell transfusion. An abdominal ultrasound was performed, revealing dilation of the left gonadal and ovarian veins. CT angiography and phlebography confirmed ovarian varices and dilation of the left gonadal and renal veins, revealing a posterior left renal vein location suggestive of posterior nutcracker syndrome. We performed surgical correction by transposing the left renal vein, with a favorable medium-term outcome.