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Nutcracker syndrome is a syndrome of compression of the left renal vein through the aorta and superior mesenteric artery. This syndrome can make itself known in many ways. The patient complains of abdominal pain, sometimes with varicose veins. Sometimes he still feels tired. So making a diagnosis is not easy. Find out what Nutcracker Syndrome is, what other symptoms it may have and how it is treated.

Nutcracker syndromeorcompression syndrome of the left renal vein through the aorta and superior mesenteric arteryis diagnosed at every stage of life, both in adults and children. It is an extremely ungrateful disease. Sometimes a doctor has to go a long way of ruling out other problems one by one before making a proper diagnosis. Meanwhile, the patient feels worse and worse. It happens that he is treated e.g. for the spine. He has been prescribed exercise, rehabilitation, and physical therapy, and he's not getting better. Fortunately, once the diagnosis is made, you recover fairly quickly as the treatment is not very complicated.

Ambiguous symptoms

Complaints suffered by people with Nutcracker Syndrome include:

  • stomach pains
  • back pain, mainly in the lumbar region (in the lower back)
  • kidney pains
  • pain in the lower abdomen
  • gastrointestinal symptoms, especially nausea, vomiting
  • anal varices (hemorrhoids)
  • varicose veins of the limbs
  • in men varicose veins of the spermatic cord
  • in women varicose veins of the ovarian plexus
  • general weakness
  • hematuria (hematuria)

What is the nutcracker syndrome

Nutcracker syndrome cannot be called a disease. Rather, it is an anatomical defect, a congenital vascular anomaly. It involves the widening of the left renal vein due to its being pinched between the abdominal aorta and the superior mesenteric artery. The vessels compress the renal vein in a manner reminiscent of the principle of the nutcracker (this term also occurs in gastroenterology - the esophagus of the nutcracker type is manifested by painful spasms of the esophagus). As a result of this pressure, the venous pressure increases, which leads to the development of collateral circulation - through the adrenal, lumbar and genital veins.

Diagnostic tests

Nutcracker Syndrome may be suspected after receiving the results of a urine test. This is indicated by proteinuria, hematuria, or hematuria. Hematuria occurs due to the direct connection between the venous sinuses, which have very thin walls, and the adjacent calyces of the kidneys. The next stage of diagnostics is Doppler ultrasound, computed tomography or magnetic resonance imaging. Typically, these methods are completely sufficient to ensure that the patient has Nutcracker Syndrome. In case of doubt, retrograde venography of the left renal vein can be performed with simultaneous pressure measurement in this vein before stenosis and in the inferior vena cava. However, it is already an invasive test.

Worth knowing

Nutcracker syndrome should be very carefully monitored during pregnancy. The movement of a woman's internal organs during this time can put even more pressure on the left renal vein. However, it also happens that this pressure relaxes during pregnancy.

How Nutcracker Syndrome is treated

It happens, especially with children, adolescents and young adults, that the syndrome goes away on its own. It is related to the processes that take place in young organisms - children grow, the proportions of the body change, and so the internal organs slightly change their position in relation to each other. At some point, the clamp on the left renal vein may decrease or disappear altogether.

In other cases, the nutcracker syndrome is treated surgically. The operation consists in unblocking the compressed vessel and restoring proper flow. The use of a stent in the compressed vein is often required. This solution gives good results, and kidney damage is very rare. In extremely severe cases, a kidney transplant is necessary (of course, its vascular pedicle is already placed in a safer place) or even a nephrectomy, i.e. removal of the kidney.

After the surgery, ultrasound of the kidneys and urine tests should be regularly performed.

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