Nutcracker Phenomenon as a Result of Celiomesenteric Trunk Aneurysm.

A common origin of the celiac trunk and superior mesenteric artery is exceedingly rare, and aneurysms of this common trunk are even rarer. According to our literature search, there are no reported cases of nutcracker syndrome or phenomenon involving this rare aneurysmal anomaly. Repair of such anomalies is standardly via open surgical approach with few reported cases of endovascular repair. We describe a patient with an aneurysm of the celiomesenteric trunk resulting in nutcracker phenomenon of the left renal vein. The celiomesenteric trunk aneurysm was repaired endovascularly, resulting in decreased surrounding inflammation and improvement of the left renal vein compression.

Nutcracker syndrome complicated with intestinal malrotation.

Nutcracker syndrome (NCS) is a pathological condition in which the left renal vein (LRV) is compressed between the superior mesenteric artery (SMA) and aorta. NCS can predispose patients to the onset of chronic kidney disease because of persistent increase in LRV pressure. Although NCS in children is often idiopathic, it can also be caused by underlying pathologies such as retroperitoneal tumours. To the best of our knowledge, there have been no reports regarding paediatric cases of NCS complicated with intestinal malrotation. Here, we report the case of a 12-year-old girl with intestinal malrotation complicated with NCS whose haematuria resolved after surgical intervention for intestinal malrotation. The present case findings indicate that intestinal malrotation with concomitant weight loss is a potential underlying aetiology in NCS. Thus, when NCS is especially diagnosed with gastrointestinal symptoms, intestinal malrotation should be considered as an underlying aetiology.

Venous Compression Syndromes.

Venous compression syndromes occur due to extrinsic compression causing complications of venous hypertension or venous thrombosis. This review focuses on 4 venous compression syndromes involving the left common iliac vein, subclavian vein, left renal vein, and popliteal vein. Clinical presentation, diagnostic methods, and management options are reviewed. When properly diagnosed and treated, long-term consequences can be avoided.

Three Unusual Cases of Nutcracker Syndrome Caused by Increased Blood Flow within the Left Renal Vein.

Nutcracker syndrome (NCS) refers to the compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery. It can cause both microscopic and gross haematuria, with or without flank pain. The diagnosis is often delayed in a majority of symptomatic patients. On the other hand, the use of CT in routine abdominal explorations has increased the detection of the compression of the LRV in healthy and asymptomatic patients, but its diagnostic value remains uncertain. In this paper, we report 3 cases of the NCS associated with an increased blood flow in the LRV, due to different conditions, which we believe could produce the appearance of clinical symptoms.

Nutcrackerlike Phenomenon Is An Unusual Cause for Gross Hematuria After a Kidney Graft.

Nutcracker phenomenon is the condition that occurs most commonly at the morphologic type by compression of the left renal vein between the aorta and superior mesenteric artery. The diagnosis is often delayed because of the variability in manifestations and absence of consensus on diagnostic criteria. We report a 30-year-old woman who presented gross hematuria several days after a kidney transplant. Nutcracker syndrome was established intraoperatively during open surgical approach for bladder clot evacuation. Renal repositioning was done with relief in the degree of hematuria intraoperatively. No episode of gross hematuria was observed on follow-up after 8 months.

Right nutcracker syndrome associated with left-sided inferior vena cava, hemiazygos continuation and persistant left superior vena cava: a rare combination.

The term nutcracker syndrome refers to compression of left renal vein between aorta and superior mesenteric artery causing renal venous hypertension. Right nutcracker syndrome associated with a left-sided inferior vena cava is an extremely rare anomaly. Reported two cases in English literature were diagnosed by ultrasonography and computed tomography angiography in adulthood. Herein, we present a case of right nutcracker syndrome with left-sided inferior vena cava and hemiazygos continuation in a 12-year-old girl.

Infrarenal abdominal aorta aneurysm: a rare cause of anterior nutcracker syndrome with associated pelvic congestion.

We present a rare case of anterior nutcracker syndrome caused by an abdominal aorta aneurysm (AAA). A 61-year-old woman was admitted to our institution for computed tomography angiography. It revealed an AAA 51 mm in diameter that was lifting off of the left renal vein toward the superior mesenteric artery, causing anterior nutcracker syndrome with consequent left renal vein compression and left ovarian vein congestion. Aneurysm resection was performed, followed by left ovarian vein ligation and left adnexectomy to prevent vein conglomerate rupture. This is the first case that describes anterior nutcracker syndrome caused by AAA, which was successfully treated by aneurysm resection.

Nutcracker syndrome due to left-sided inferior vena cava compression and treated with superior mesenteric artery transposition.

Left renal vein hypertension secondary to left renal vein compression has been described as a cause of persistent hematuria in nutcracker syndrome. Malformation of the inferior vena cava (IVC), although rare and frequently asymptomatic, may also result in left renal vein hypertension, with resultant hematuria when it is severely compressed. We report a 20-year-old man with persistent hematuria due to compression of left-sided IVC. The patient was successfully treated by means of superior mesenteric artery (SMA) transposition and division of the fibrous bundle at the origin of the SMA. His postoperative course was uneventful. Compression of the left IVC is a unique form of nutcracker syndrome. SMA transposition, together with division of a fibrous bundle at the origin of the SMA if present, is a safe and effective surgical procedure for this special entity.