Nutcracker Syndrome, Diagnosis and Management: A Case Series

Nutcracker syndrome is a rare disease, so our purpose of the study is to diagnose this disease and management. The nutcracker phenomenon is the compression of the left renal vein (LRV) between the abdominal aorta and the superior mesenteric artery. When symptoms such as flank pain and hematuria accompany this phenomenon, it is called nutcracker syndrome. We here report you four cases of nutcracker syndrome, a 15 year male, a 17 year female, 32 year female, and a 39 year female patient, referred to the cardiothoracic and vascular surgery outpatient department of our tertiary care center, with complaints of left side flank pain and ultrasound abdomen and pelvis showing dilated and tortuous LRV. All underwent serological and radiological investigations for a better understanding of the severity and anatomy of the disease. Eventually, a preoperative workup was done and they underwent re-positioning of the LRV. Four patients with nutcracker syndrome were operated on with transposition of the LRV. Postoperatively, three patients have no symptoms and one patient has microscopic hematuria on routine urine microscopy. Nutcracker is a rare disease. Four cases operated with transposition of the LRV, postoperative, and follow-up were uneventful.