Nutcracker Syndrome; Diagnostic Challenges, Surgical Management, and Outcome

Background: Nutcracker syndrome (NCS) is a rare and often underdiagnosed vascular compression disorder, primarily involving the entrapment of the left renal vein (LRV) between the superior mesenteric artery and the abdominal aorta. This study presents a retrospective study of nine patients diagnosed with NCS who underwent surgical intervention, aiming to explore diagnostic challenges and surgical management outcomes. Methods: We conducted a retrospective analysis of nine patients diagnosed with NCS and treated surgically at our institution from 2021 to 2024. Data collected included patient demographics, clinical presentations, diagnostic findings, surgical procedures, and postoperative outcomes. Results: The cohort consisted of six females (aged 24–30 years) and three males (aged 14–22 years) diagnosed with NCS and treated surgically at our institution between 2021 and 2024. The main presenting symptoms included chronic abdominal pain, hematuria, and urogenital symptoms. The diagnosis was confirmed using ultrasonography and computed tomography angiography, which revealed narrowed aorta-mesenteric angles (18°–45°) and LRV compression. All patients underwent LRV reimplantation through a midline transperitoneal approach. Postoperative recovery was uneventful, with normal venous flow observed on Doppler studies between postoperative days 3 and 4. Patients experienced significant symptom improvement and were discharged within 4–6 days postsurgery. Conclusion: This case series demonstrates that LRV reimplantation is an effective surgical approach for managing NCS. Early diagnosis with appropriate imaging and timely surgical intervention can lead to favorable outcomes in a diverse patient population. Further research is warranted to assess the long-term efficacy of this surgical technique.