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Case Reports
. 2014 Oct;6(4):352-5.
doi: 10.4103/0974-7796.141004.

Modified medial nephropexy for treatment of the anterior nutcracker syndrome

Wissem Hmida  1 , Faouzi Mallat  1 , Mouna Ben Othmen  1 , Faouzi Limayem  1 , Faouzi Mosbah  1
Affiliations
Case Reports

Modified medial nephropexy for treatment of the anterior nutcracker syndrome

Wissem Hmida et al. Urol Ann. 2014 Oct.

Abstract

We report the case of a 15-year-old male, presenting with recurrent gross hematuria complicated by acute anemia. Cystoscopy showed little bleeding from the left ureteral orifice. Diagnosis of left renal vein compression at the aortomesenteric space was established through color Doppler ultrasonography and computed tomographic angiography. Therapeutic attitude was interventionist in our case, performing successful management with modified medial nephropexy, with a retroperitoneal approch. To the best of our knowledge, we report the second case of left medial nephropexy for treatment of the anterior nutcracker syndrome. The first case of modified medial nephropexy was done by lowering the left renal vein from its initial position in the aortomesenteric angle through a restrict retroperitoneal approach.

Keywords: Anterior nutcracker syndrome; medial nephropexy; retroperitoneal approach.

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Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
Computer tomography angiography demonstrates compression of the left renal vein between the aorta and superior mesenteric artery with dilation of the distal part of the left renal vein on the axial cuts
Figure 2
Figure 2
CT angiography demonstrates the acute angle between the aorta and superior mesenteric artery
Figure 3
Figure 3
CT scan performed one month later shows the normal aspect of the kidney, except a little hematoma at the upper pole of the kidney and no compression of the left renal vein
Figure 4
Figure 4
Doppler ultrasonography of the left renal vein showed normal blood flow without compression
See this image and copyright information in PMC

References

    1. Wendel RG, Crawford ED, Hehman KN. The Nutcracker phenomenon; an unusual cause for renal varicosities with hematuria. J Urol. 1980;123:761–3. - PubMed
    1. Ahmed K, Sampath R, Khan MS. Current trends in the diagnosis and management of renal nutcracker syndrome: A review. Eur J Vasc Endovasc Surg. 2006;31:410–6. - PubMed
    1. Lau X, Lo R, Chan FL, Wong KK. The posterior: Hematuria secondary to retroaortic left renal vein. Urology. 1986;28:437–9. - PubMed
    1. Luo XL, Qian GN, Xiao H, Zhao CL, Zhou XD. Posterior nutcracker syndrome associated with interrupted left inferior vena cava with azygos continuation and retroaortic right renal vein. Korean J Radiol. 2012;13:345–9. - PMC - PubMed
    1. Barnes R, Fleisher Hr, Redman J, Smith JW, Harshfield DL, Ferris EJ. Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): Repair by a new stenting procedure. J Vasc Surg. 1988;8:415–21. - PubMed

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