Presentation
Our case report shows an exceptional cause and presentation of a NCS. This is a rare entity, with diverse presentations that provides a variety of signs and symptoms. [urologyannals.com]
A 34-year-old woman presented with left flank pain and discomfort. [ncbi.nlm.nih.gov]
NCS can differentiate clinically into 2 subtypes as follows: typical presentation (or renal presentation) and atypical presentation (or urologic presentation). [wjgnet.com]
This entity affects women more than men and in most cases present in the third or fourth decades of life [5]. [ijcasereportsandimages.com]
Age at presentation can range from childhood to the seventh decade, but most symptomatic patients typically present in the second or third decade [7]. [oatext.com]
Gastrointestinal
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Abdominal Pain
The syndrome is manifested by left flank and abdominal pain, with or without unilateral haematuria. [ncbi.nlm.nih.gov]
A 24-year-old male presented to our institution with worsening abdominal pain in the setting of a seven-year history of chronic fatigue syndrome, chronic pelvic pain syndrome, and vague abdominal pain. [oatext.com]
Diagnosis is challenging because it is one of the relatively rare non-gastrointestinal causes of abdominal pain (table). [vascsurg.me]
METHODS: A healthy 19 year old female with a BMI 19 presented with a 2 year history abdominal pain without a discernable etiology. [meeting.savs.org]
This syndrome can manifest by the left flank and abdominal pain, with or without macroscopic or microscopic haematuria. [urologyannals.com]
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Bilious Vomiting
The patient visited our outpatient clinic presenting bilious vomiting and indigested vomitus for 3 consecutive days. He had lost 20 kg during military service. [ncbi.nlm.nih.gov]
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Severe Abdominal Pain
We present here a case of an 18-year-old boy with severe abdominal pain promoted by an antero-posterior NCS. Our case report shows an exceptional cause and presentation of a NCS. [urologyannals.com]
Skin
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Flushing
The LRV was selected with a Cobra 2 catheter (Cook Medical, Bloomington, IN) and a 0.035-inch hydrophilic Glidewire (Terumo Interventional Systems), and the Cobra 2 catheter was exchanged for a straight flush catheter. [evtoday.com]
After the resected kidney was extracted through the oblique incision pre-prepared under the retroperitoneal tunnel, it was placed immediately on crushed ice and flushed with iced UW solution at 4 C. [jmedicalcasereports.biomedcentral.com]
Neurologic
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Chorea
Huntington Disease and Other Genetic Choreas. ... (2011) The neuropsychiatry of neuroacanthocytosis syndromes. ... (2011) Young-Onset Parkinsonism in a Hong Kong Chinese Man With Adult-Onset Hallervorden–Spatz Syndrome. ... [archive.is]
Urogenital
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Chronic Pelvic Pain
Have suffered from severe chronic pelvic pain for 8 months now, finally met a vascular surgeon who thinks I have nutcracker syndrome, had a venogram done by an interventional radiologist, will see dr. next week to discuss surgery. [medhelp.org]
Pelvic congestion syndrome, causing symptoms such as chronic pelvic pain, pain during intercourse, painful or difficult urination, painful menstrual cramps during periods, and polycystic ovaries. Orthostatic proteinuria. [rarediseases.info.nih.gov]
Physical examination may demonstrate the presence of varicocele in males and pelvic varicose veins in females with symptoms of chronic pelvic pain or dysmenorrhea5. Also arteriovenous fistulas associated with Nutcracker Syndrome have been described. [bjuinternational.com]
Chronic pelvic pain: The role of the nutcracker syndrome. J Vasc Bras 2008;7:76-9. 7. Barnes RW, Fleisher HL 3 rd, Redman JF, Smith JW, Harshfield DL, Ferris EJ. [urologyannals.com]
Workup
Gastrointestinal workup including gastric emptying study, esophagogastroduodenoscopy and colonoscopy were negative, as was a workup for kidney stones. Eventually she was referred to my clinic for management of nutcracker syndrome. [vascsurg.me]
X-Ray
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Pneumoperitoneum
Muscular layers of the incision were sutured and the wound was temporarily protected by membrane in order to maintain the normal pressure of CO 2 pneumoperitoneum. Then the patient was turned over and placed in a lateral decubitus position. [jmedicalcasereports.biomedcentral.com]
Treatment
Treatment criteria are not well established, however for asymptomatic patients with no haematuria, the treatment remains conservative. [pubs.sciepub.com]
Treatment of the NCS is controversial and there are several available options, including follow-up, conservative treatment and surgical therapy. [urologyannals.com]
[…] for the treatment of the NCS. [29] Hohenfellner et al reported their experience with transposition of the LRV in treatment of the NCS. [sjkdt.org]
Nutcracker Syndrome Treatment Nutcracker syndrome treatments can vary based on your age, symptoms, and the severity of your condition. [upmc.com]
Treatments Potential treatment for a nutcracker syndrome may include the following options: Conservative treatment - If the symptoms are mild, conservative treatment (without surgery or endovascular treatment) can be considered. [drpeterlin.com]
Prognosis
Treatment and prognosis Treatment should be started strictly when it is causing symptoms (hematuria and left flank pain). Surgical treatment modalities have their inherent complications and should be contemplated only when strongly indicated. [radiopaedia.org]
Nutcracker syndrome recovery time and prognosis Stenting: Recovery time for nutcracker syndrome stenting can last 2-3 months. This allows time for the body to accept the stent and for new tissue to surround it. [upmc.com]
Etiology
Other etiologic hypotheses of nutcracker syndrome include posterior renal ptosis with resultant stretching of the left renal vein over the aorta, and abnormal branching of the superior mesenteric artery from the aorta. 6 Controversy exists about obtaining [appliedradiology.com]
METHODS: A healthy 19 year old female with a BMI 19 presented with a 2 year history abdominal pain without a discernable etiology. [meeting.savs.org]
Etiology [ edit ] In normal anatomy, the LRV travels between the SMA and the AA. [3] Occasionally, the LRV travels behind the AA and in front of the spinal column. [en.wikipedia.org]
In one study by Shin et al [18], the etiology of isolated hematuria was not identified by routine methods in 69% of pediatric cases. Further investigation with renal Doppler ultrasonography identified 40% of those to have nutcracker phenomenon. [oatext.com]
Epidemiology
The retroaortic or circumaortic renal vein may be compressed between the aorta and the vertebral body, which is called posterior nutcracker. [5] Epidemiologically, this entity occurs more frequently in women and is diagnosed within the second and third [indjvascsurg.org]
Epidemiologically, this entity occurs more frequently in women and is diagnosed within the 3rd and 4th decade of life, our case however was in a 17 year-old male. [bjuinternational.com]
Epidemiologically, the NCS occurs more frequently in women and is diagnosed within the 3 rd and 4 th decade of life; our case however was in an 18-year-old male. [urologyannals.com]
Pathophysiology
We review the pathophysiology as well as treatment options for this uncommon disorder. [vasculardiseasemanagement.com]
The nutcracker syndrome: new aspects of pathophysiology, diagnosis and treatment. J Urol 1991;146: 685-8. Shokeir AA, EL-Diasty TA, Ghoneim MA. The nutcracker syndrome: new methods of diagnosis and treatment. Br J Urol 1994;74:139-43. [latunisiemedicale.com]
The underlying pathophysiology of the NCS is not fully understood. [sjkdt.org]
White that performing venography in as upright a position as possible recreated the pathophysiology, the physics, particularly for pelvic congestion and nutcracker. Remember, this is a disease of bipedalism, of upright posture. [vascsurg.me]
Hohenfellner M, Steinbach F, Schultz-Lampel D, Schantzen W, Walter K, Cramer BM, Thüroff JW, Hohenfellner R: The nutcracker syndrome: new aspects of pathophysiology, diagnosis and treatment. J Urol. 1991, 146: 685-688. PubMed 10. [springermedizin.de]
Prevention
This arrangement prevents SMA from compressing the LRV (1). Both SMA and LRV anomalies have been pointed out as the primary cause of Nutcracker Syndrome. [syndromespedia.com]
To prevent potential stent migration, either during deployment or afterward, we also chose to use a longer (ie, 60 mm) stent, with extension from the gonadal vein to 1 cm into the IVC. [evtoday.com]
[…] that it is a largely unknown or under reported symptom, mainly because there is no definitive test to establish you have it so you might only find out you have this for sure if and when the collateral blood flow to the bowel becomes insufficient to prevent [forums.phoenixrising.me]
[…] vein: a segment of the great saphenous vein is used as a second connection between the LRV and the IVC to alleviate pressure build up. [7] Renal autotransplantation: transfer of a kidney from its original location into the body to another location to prevent [en.wikipedia.org]
It will enhance the renal vein and prevent the collapse of the portion between the renal vein and aorto-mesenteric clamp. This technique was described for the first time in 1988 by Barnes. [bjuinternational.com]