Nutcracker syndrome complicated with intestinal malrotation

Abstract

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.

Keywords: gastrointestinal surgery; haematuria; paediatrics.

Figure 1

Contrast-enhanced CT images. (A) Coronal, (B) axial and (C) sagittal images of severely compressed left renal vein (asterisk) between the superior mesenteric artery (arrow) and aorta (arrowhead). Note that the duodenum does not pass through the aortomesenteric angle and the small intestine, in most parts, is present at right side of the abdomen.