Baylor College of Medicine, Houston, TX, USA.
Expert Pain Care, Houston, TX, USA.
J Med Case Rep. 2020 Jul 3;14(1):102. doi: 10.1186/s13256-020-02398-6.
Nutcracker syndrome is a rare disorder caused by compression of the left renal vein, usually between the aorta and the superior mesenteric artery. It typically presents with left-sided abdominal pain and hematuria. Left renal vein transposition is the most commonly employed surgical technique to alleviate the compression.
A 22-year-old Caucasian man with a known diagnosis of nutcracker syndrome had undergone left renal vein transposition 1 year before presentation without any subsequent pain relief. In addition, his surgery was complicated by massive blood loss and a 1-week-long stay in an intensive care unit (ICU); as such, he was not amenable to further surgical intervention or stenting to treat his underlying pathology. His symptoms included constant sharp left-sided flank, perineal, and testicular pain. A series of ganglion impar blocks were performed every 3-4 months over the course of 5 years with substantial pain relief achieved.
Our case report highlights a treatment option that has not yet been described for patients with pain secondary to nutcracker syndrome refractory to surgical intervention.
胡桃夹综合征是一种罕见的疾病，由左肾静脉受压引起，通常发生在主动脉和肠系膜上动脉之间。其典型表现为左侧腹痛和血尿。左肾静脉移位是缓解压迫最常用的手术技术。
一名 22 岁的白人男性，已知患有胡桃夹综合征，在就诊前 1 年接受了左肾静脉移位术，但没有缓解任何后续疼痛。此外，他的手术还伴有大量失血和长达 1 周的重症监护病房（ICU）住院治疗；因此，他不适合进一步的手术干预或支架置入来治疗潜在的病理。他的症状包括持续的左侧腰部、会阴和睾丸锐痛。在 5 年的时间里，每隔 3-4 个月进行一系列的交感神经节阻滞，疼痛得到了显著缓解。
我们的病例报告强调了一种治疗选择，对于手术干预无效的胡桃夹综合征引起的疼痛患者，这是一种尚未描述的治疗选择。
