A Misdiagnosed Patient with Recurrent Abdominal Pain: Nutcracker Syndrome

Abstract

Nutcracker phenomenon is characterized by impeded outflow from the left renal vein into the inferior vena cava because of extrinsic left renal vein compression. Because of its rarity and excessive misdiagnosis, we report the case of a 30-year-old female patient who was admitted to the emergency department of our hospital with recurrent left flank and lower abdominal pain andwas diagnosed with nutcracker syndrome. A 30-year-old female patient was admitted tothe emergency department of our hospital with recurrent left flank and lower abdominal pain. Physical examination showed a flaccid abdomen, which was painful onpalpation of the lower portion and left flank, without any signs of peritoneal irritation as well as theabsence of vulvar or lower limb varices. In the work-up, abdominal computed tomography with intravenous contrast was used and revealed compression of the left renal vein between the aorta and superior mesenteric artery. Therefore, the patient was referred to the vascular and endovascular surgery department to evaluate the possibility of a minimally invasive treatment. There is a wide spectrum of clinical presentations of nutcracker syndrome, and the diagnostic criteria are not well defined, frequently resulting in delayed or incorrect diagnosis. From the number of cases reported in the literature, it is obvious that this condition is not very common. Therefore, nutcracker syndrome must kept in mind in patients with recurrent flank and lower abdominal pain duringdifferential diagnosis.

Keywords

• Nutcracker syndrome
• renal vein entrapment
• recurrent abdominal pain