Korean J Urol.  1996 Sep;37(9):1027-1030.

A Case or Nutcracker Syndrome Surgically Corrected by Extraperitoneal Flank Approach

• Lee SE
• Cho SW
• Yang SC

Abstract

Nutcracker syndrome is a rare disease caused by the compression of the renal vein between the aorta and superior mesenteric artery. It is known to cause of venous hypertension, peripelvic and periureteral varicosities. Clinical manifestations include varicocele, hematuria, and flank or abdominal pain. Surgical correction is needed in nutcracker syndrome cases with severe or recurrent hematuria and abdominal or flank pain. Reanastomosis of the renal vein at 5cm below the original insertion site at the inferior vena cava is the one of the most common corrective methods and the transabdominal approach is usually employed. This disease usually appears in healthy young people and in order to decrease postoperative complications such as intestinal obstruction and bowel adhesion by avoiding unnecessary intraperitoneal manipulation, the authors used the extraperitoneal approach through a flank incision. We report because, in selected cases, we consider that this extraperitoneal approach is one of the alternative methods for the usual transperitoneal approach.

Keyword

nutcracker syndrome; extraperitoneal approach; renal vein; hematuria

MeSH Terms

Abdominal Pain
Aorta
Flank Pain
Hematuria
Hypertension
Intestinal Obstruction
Mesenteric Artery, Superior
Postoperative Complications
Rare Diseases
Renal Veins
Varicocele
Vena Cava, Inferior