Maloni Krystal C, Calligaro Keith D, Lipshutz William, Vani Kunal, Troutman Douglas A, Dougherty Matthew J
Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA.
Vasc Endovascular Surg. 2020 Apr;54(3):283-285. doi: 10.1177/1538574419896721. Epub 2019 Dec 30.
Nutcracker syndrome is a rare entity in which compression of the left renal vein (LRV), usually by the overlying superior mesenteric artery (SMA), results in renal venous congestion and reflux in the left ovarian vein (LOV). Patients may present with hematuria, left flank pain, dyspareunia, and vaginal or abdominal wall varicose veins. We report a patient with nutcracker syndrome who presented atypically with left flank pain that was exacerbated in the postprandial state. We hypothesize that the physiologic dilation of the SMA after oral intake caused increased LRV compression at that site and augmented lateral LRV distention. The patient had no evidence of SMA syndrome or chronic mesenteric insufficiency. Her symptoms resolved after we performed an LOV to inferior vena cava transposition.
胡桃夹综合征是一种罕见病症，其中左肾静脉（LRV）通常受到上方肠系膜上动脉（SMA）的压迫，导致肾静脉淤血以及左卵巢静脉（LOV）反流。患者可能出现血尿、左侧胁腹疼痛、性交困难以及阴道或腹壁静脉曲张。我们报告了一名胡桃夹综合征患者，其表现不典型，餐后左侧胁腹疼痛加剧。我们推测，口服摄入后SMA的生理性扩张导致该部位对LRV的压迫增加，进而使LRV外侧扩张加剧。该患者没有SMA综合征或慢性肠系膜缺血的证据。在我们进行了LOV至下腔静脉转位术后，她的症状得到缓解。
