Öz
Aim: Nutcracker syndrome is a very rare cause in patients presenting to the emergency department with abdominal pain. Early consideration in differential diagnosis will reduce the time spent for diagnosis and morbidity, as well as provide the correct treatment. We aimed to contribute to the literature by determining the clinical relations of these cases with laboratory, imaging and treatment data.
Material and Method: Twenty-seven patients over the age of 16 who presented to the emergency department with abdominal pain between January 2000 and December 2020 were included in this study. The ages of the patients were between 16-39 and the mean was 25.19±7.00 years. Demographic characteristics, clinical findings, laboratory parameters, radiological evaluations, and treatment modalities of patients were evaluated retrospectively.
Results: Abdominal pain and flank pain were the most common reasons for admission to the emergency department of 27 patients included in the study. In the anterior group, 17 (77%) patients had flank pain, 10 (45%) patients had dysmenorrhea, 11 (50%) hematuria, 10 (45%) proteinuria, and 9 (40%) patients hematuria and proteinuria. In the posterior group, there was no hematuria, proteinuria, anorexia, nausea and vomiting, and oral intolerance. In cases with anteior nutcracker syndrome, 12 (54%) doppler ultrasonography, 13 (59%) computed tomography, 5 (22%) magnetic resonance imaging were performed. Conservative treatment was applied to 11 (40%) patients in the anterior group and 3 (11%) patients in the posterior group. Endovascular surgery was performed on 5 (22%) female patients.
Conclusion: Nutcracker syndrome should be investigated in adult patients who present to the emergency department with abdominal pain and whose diagnosis is unclear. Early diagnosis is critical in terms of treatment and morbidity.
Anahtar Kelimeler
Emergency department abdominal pain nutcracker syndrome hematuria proteinuria
Destekleyen Kurum
None
Kaynakça
- El-Sadr AR, Mina E. Anatomical and surgical aspects in the operative management of varicocele. Urol Cutaneous Rev 1950; 54: 257-62.
- De Schepper A. “Nutcracker” phenomenon of the renal vein and venous pathology of the left kidney. J Belge Radiol 1972; 55: 507-11.
- Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc 2010; 85: 552-9.
- Arima M, Hosokawa S, Ogino T, Ihara H, Terakawa T, Ikoma F. Ultrasonographically demonstrated nutcracker phenomenon: alternative to angiographt. Int Urol Nephrol 1990; 22: 3-6.
- Gulleroglu K, Gulleroglu B, Baskin E. Nutcracker syndrome. World J Nephrol 2014; 3: 277-81.
- Shin JI, Baek SY, Lee JS, Kim MJ. Follow-up and treatment of nutcracker syndrome. Ann Vasc Surg 2007; 21: 402.
- Nakazawa S, Nakano K, Nakagawa M, Kishikawa H, Nishimura K. Nutcracker syndrome with left inferior vena cava: a case report. Hinyokika Kiyo 2015; 61: 329–33.
- Shah D, Qiu X, Shah A, Cao D. Posterior nutcracker syndrome with left renal vein duplication: an uncommon cause of hematuria. Int J Surg Case Rep 2013; 4: 1142-4.
- Knipp B, Knechtges P, Gest T, Wakefield T. “Inferior vena cava: embryology and anomalies,” in aortic aneurysms: pathogenesis and treatment, GR. Upchurch Jr. and E. Criado, Eds., Humana Press, NY, USA, 2009: 289–307.
- Orczyk K, Łabȩtowicz P, Lodziński S, Stefańczyk L, Topol M, Polguj M. The Nnutcracker syndrome. Morphology and clinical aspects of the important vascular variations: a systematic study of 112 cases. Int Angiology 2016; 35: 71–7.
- Cakici E, Yazilitas F, Cinar HG, et al. Nutcracker syndrome in children: the role of Doppler ultrasonography in symptomatic patients. Turk J Pediatr Dis 2019; 5: 348-52.
- Luo XL, Qian GN, Xiao H, Zhao CL, Zhou XD. Posterior nutcracker syndrome associated with interrupted left inferior vena cava with azygos continuation and retro aortic right renal vein. Korean Journal of Radiology 2012; 13: 345-9.
- Shin JI, Lee JS, Kim MJ. The prevalance, physical characteristics and diagnosis of nutcracker syndrome. Eur J Vasc Endovasc Surg 2006; 32: 335-6.
- Hwang SK, Cho MH, Ko CW. Nutcracker syndrome in children with orthostatic proteinuria: diagnosis on the basis of venography. Korean J Nephrol 2008; 27: 446-51.
- Ekim M, Ozçakar ZB, Fitoz S, et al. The “nutcracker phenomenon” with orthostatic proteinuria: case reports. Clin Nephrol 2006; 65: 280-3.
- Shi Y, Yang H, Feng Z, Chen F, Zhang H, Wu Z. Evaluation of posterior nutcracker phenomenon using multisection spiral CT. Clinical Radiology 2018; 73: 1060.
- Noorani A, Walsh SR, Cooper DG, Varty K. Entrapment syndromes. Eur J Vasc Endovasc Surg 2009; 37: 213-20.
- Takahashi Y, Sano A, Matsuo M. An ultrasonographic classification for diverse clinical symptoms of pediatric nutcracker phenomenon. Clin Nephrol 2005; 64: 47–54.
- Fitoz S, Ekim M, Ozcakar ZB, Elhan AH, Yalcinkaya F. Nutcracker syndrome in children the role of upright position examination and superior mesenteric artery angle measurement in the diagnosis. J Ultrasound Med 2007; 26: 573–80.
- Kim SH, Cho SW, Kim HD, Chung JW, Park JH, Han MC. Nutcracker syndrome: diagnosis with Doppler US. Radiology 1996; 198: 93-7.
- Wang L, Yi L, Yang L, et al. Diagnosis and surgical treatment of nutcracker syndrome: a single-center experience. Urology 2009; 73: 871-6.
- Inal M, Unal Daphan B, Karadeniz Bilgili MY. SMA syndrome accompanying with nutcracker syndrome: a case report. Iranian Red Crescent Medical Journal 2014; 16: 14755.
- Baril DT, Polanco P, Makaroun MS, Chaer RA. Endovascular management of recurrent stenosis following left renal vein transposition for the treatment of Nutcracker syndrome. J Vasc Surg 2011; 53: 1100-3.
- Ahmed K, Sampath R, Khan MS. Current trends in the diagnosis and management of renal nutcracker syndrome: a review. Eur J Endovasc Surg 2006; 31: 410-6.
Öz
Amaç: Acil servise karın ağrısı ile başvuran hastalarda Nutcracker Sendromu çok nadir ortaya çıkan bir nedendir. Ayırıcı tanıda erken dönemde akla getirilmesi, hastanın tanı için geçirdiği süreyi ve morbiditeyi azaltacağı gibi, doğru tedaviyi uygulamayı da sağlayacaktır. Literatür eşliğinde bu olguların değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Bu çalışmaya, Ocak 2000-Aralık 2020 tarihleri arasında acil servise karın ağrısı nedeniyle başvuran 16 yaşından büyük 27 hasta dahil edildi. Hastaların yaşları 16 ile 39 arasındaydı ve ortalaması 25.19±7.00 yıldı. Bu hastaların demografik özellikleri, klinik bulguları, laboratuar parametreleri, radyolojik değerlendirmeleri ve tedavi şekilleri retrospektif olarak değerlendirildi.
Bulgular: Çalışmaya dahil edilen 27 olgunun acil servise en sık başvuru nedeni karın ağrısı ve yan ağrısıydı. Anterior grupta 17 (%77) hastada yan ağrısı, 10 (%45) hastada dismenore mevcutken, 11 (%50) hematüri, 10 (%45) proteinüri ve 9 (%40) hematüri ve proteinüri olgusu vardı. Posterior grupta hematüri, proteinüri, iştahsızlık, bulantı ve kusma ve oral intolerans yoktu. Anterior Nutcracker Sendromu grubunda 12 (%54) Doppler ultrasonografi, 13 (%59) bilgisayarlı tomografi, 5 (%22) manyetik rezonans görüntüleme yapıldı. Anterior grupta 11 (%40) hastaya, posterior grupta 3 (%11) hastaya konservatif tedavi uygulandı. 5 (%22) kadın hastaya endovasküler cerrahi uygulandı.
Sonuç: Erişkin dönemde acil servise karın ağrısıyla başvurun ve tanısı geciken olgularda Nutcracker sendromu düşünülmelidir. Erken tanı değerlendirmesi; tedavi ve morbidite açısından önem taşımaktadır.
Anahtar Kelimeler
Acil servis karın ağrısı nutcracker sendromu hematüri proteinüri
Kaynakça
- El-Sadr AR, Mina E. Anatomical and surgical aspects in the operative management of varicocele. Urol Cutaneous Rev 1950; 54: 257-62.
- De Schepper A. “Nutcracker” phenomenon of the renal vein and venous pathology of the left kidney. J Belge Radiol 1972; 55: 507-11.
- Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc 2010; 85: 552-9.
- Arima M, Hosokawa S, Ogino T, Ihara H, Terakawa T, Ikoma F. Ultrasonographically demonstrated nutcracker phenomenon: alternative to angiographt. Int Urol Nephrol 1990; 22: 3-6.
- Gulleroglu K, Gulleroglu B, Baskin E. Nutcracker syndrome. World J Nephrol 2014; 3: 277-81.
- Shin JI, Baek SY, Lee JS, Kim MJ. Follow-up and treatment of nutcracker syndrome. Ann Vasc Surg 2007; 21: 402.
- Nakazawa S, Nakano K, Nakagawa M, Kishikawa H, Nishimura K. Nutcracker syndrome with left inferior vena cava: a case report. Hinyokika Kiyo 2015; 61: 329–33.
- Shah D, Qiu X, Shah A, Cao D. Posterior nutcracker syndrome with left renal vein duplication: an uncommon cause of hematuria. Int J Surg Case Rep 2013; 4: 1142-4.
- Knipp B, Knechtges P, Gest T, Wakefield T. “Inferior vena cava: embryology and anomalies,” in aortic aneurysms: pathogenesis and treatment, GR. Upchurch Jr. and E. Criado, Eds., Humana Press, NY, USA, 2009: 289–307.
- Orczyk K, Łabȩtowicz P, Lodziński S, Stefańczyk L, Topol M, Polguj M. The Nnutcracker syndrome. Morphology and clinical aspects of the important vascular variations: a systematic study of 112 cases. Int Angiology 2016; 35: 71–7.
- Cakici E, Yazilitas F, Cinar HG, et al. Nutcracker syndrome in children: the role of Doppler ultrasonography in symptomatic patients. Turk J Pediatr Dis 2019; 5: 348-52.
- Luo XL, Qian GN, Xiao H, Zhao CL, Zhou XD. Posterior nutcracker syndrome associated with interrupted left inferior vena cava with azygos continuation and retro aortic right renal vein. Korean Journal of Radiology 2012; 13: 345-9.
- Shin JI, Lee JS, Kim MJ. The prevalance, physical characteristics and diagnosis of nutcracker syndrome. Eur J Vasc Endovasc Surg 2006; 32: 335-6.
- Hwang SK, Cho MH, Ko CW. Nutcracker syndrome in children with orthostatic proteinuria: diagnosis on the basis of venography. Korean J Nephrol 2008; 27: 446-51.
- Ekim M, Ozçakar ZB, Fitoz S, et al. The “nutcracker phenomenon” with orthostatic proteinuria: case reports. Clin Nephrol 2006; 65: 280-3.
- Shi Y, Yang H, Feng Z, Chen F, Zhang H, Wu Z. Evaluation of posterior nutcracker phenomenon using multisection spiral CT. Clinical Radiology 2018; 73: 1060.
- Noorani A, Walsh SR, Cooper DG, Varty K. Entrapment syndromes. Eur J Vasc Endovasc Surg 2009; 37: 213-20.
- Takahashi Y, Sano A, Matsuo M. An ultrasonographic classification for diverse clinical symptoms of pediatric nutcracker phenomenon. Clin Nephrol 2005; 64: 47–54.
- Fitoz S, Ekim M, Ozcakar ZB, Elhan AH, Yalcinkaya F. Nutcracker syndrome in children the role of upright position examination and superior mesenteric artery angle measurement in the diagnosis. J Ultrasound Med 2007; 26: 573–80.
- Kim SH, Cho SW, Kim HD, Chung JW, Park JH, Han MC. Nutcracker syndrome: diagnosis with Doppler US. Radiology 1996; 198: 93-7.
- Wang L, Yi L, Yang L, et al. Diagnosis and surgical treatment of nutcracker syndrome: a single-center experience. Urology 2009; 73: 871-6.
- Inal M, Unal Daphan B, Karadeniz Bilgili MY. SMA syndrome accompanying with nutcracker syndrome: a case report. Iranian Red Crescent Medical Journal 2014; 16: 14755.
- Baril DT, Polanco P, Makaroun MS, Chaer RA. Endovascular management of recurrent stenosis following left renal vein transposition for the treatment of Nutcracker syndrome. J Vasc Surg 2011; 53: 1100-3.
- Ahmed K, Sampath R, Khan MS. Current trends in the diagnosis and management of renal nutcracker syndrome: a review. Eur J Endovasc Surg 2006; 31: 410-6.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Research Articles [en] Araştırma Makaleleri [tr] |
| Yazarlar | |
| Yayımlanma Tarihi | 26 Aralık 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 3 Sayı: 4 |
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