Breaking the Nutcracker: a case-based review of diagnosis and surgical treatment

Nutcracker syndrome is a rare condition caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. This results in increased venous pressure, leading to haematuria, flank pain, and pelvic discomfort, particularly in individuals with low body mass index. Diagnosis is often challenging due to nonspecific symptoms and overlap with other pelvic disorders. We report a case of a 49-year-old woman with persistent left flank pain, dysmenorrhea, and recurrent vaginal bleeding. Imaging confirmed compression of the left renal vein. A conservative approach with nutritional support was initially attempted, but due to ongoing symptoms, the patient underwent surgical transposition of the vein with patch angioplasty using bovine pericardium. This case underscores the need to consider Nutcracker syndrome in patients with unexplained haematuria and flank pain, especially in underweight women. We also review current diagnostic tools and treatment options for this uncommon vascular condition.