ВАГІТНІСТЬ ЯК ПРИЧИНА РІДКІСНОГО ВАРІАНТА ПРАВОБІЧНОГО СИНДРОМУ ЛУСКУНЧИКА

Nutcracker syndrome (NS) is a rare pathology that occurs when the left renal vein (LRV) is compressed between the aorta and the superior mesenteric artery. This anomaly is rarely diagnosed due to low awareness and polymorphism of clinical manifestations, but the consequences of phlebohypertension in the left renal vein system (left-sided varicocele, left-sided pudendal varices, hematuria, proteinuria and, in some cases, renal failure) constitute a significant medical and social problem. Right-sided NS is an even rarer variant of the group of abdominal vascular compression syndromes (AVCS). Pregnancy is a determining factor contributing to right-sided NS due to extravasal compression of the right renal vein by the gravid uterus. The aim of our study was to analyze an unusual clinical case of right-sided NS with an atypical clinical picture, which confirms the need for physicians to be aware of AVCS. An example of a complex diagnosis of right-sided NS with an atypical clinical manifestation in a 24-year-old patient who was urgently hospitalized in the surgical department with a clinic of acute appendicitis on the 3rd day after delivery is presented. The patient underwent a preoperative ultrasound examination of the abdominal cavity and pelvic organs – multiple hypoechoic masses in the right iliac region measuring 1.5 – 1.7 cm were visualized. Intraoperatively, a large varicose, tortuous, thrombosed right ovarian vein was verified, which was removed in its entirety along with the right appendages. The postoperative period was without complications. She was discharged on the 7th day. According to the control ultrasound examination on the 5th day after the intervention, no pathology was detected. There are no clinical symptoms in the long-term postoperative period. Pelvic phlebostasis is a pathology that occurs mainly in women of reproductive age, but to date there is no data on its impact on the occurrence of idiopathic forms of infertility, pregnancy, the course of childbirth, the occurrence and course of gynecological pathology. It is known that pelvic varicose veins not only accompany various gynecological diseases, but also cause chronic pelvic pain (pelvic congestion syndrome). Pelvic varices have until now been more often considered an incidental diagnostic finding. At a young age, asymptomatic forms of the disease are more often diagnosed, in which organic changes in the venous system of the small pelvis are detected only when using additional research methods. At the same time, about 10 % of gynecological patients suffer from chronic pelvic pain. These patients have been unsuccessfully examined and treated for years for chronic inflammatory processes of the appendages, genital endometriosis. According to various data, the cause of pelvic venous congestion in 74 % of cases is NS, in 17 % – May-Turner syndrome, in 9 % – a combination of these two causes. The pronounced polymorphism of clinical manifestations significantly complicates the diagnosis and management of vascular compression syndromes, decompensated forms of pelvic venous congestion require a multidisciplinary approach and timely adequate surgical treatment.