Nutcracker syndrome

Discussion:

This case highlights the importance of thorough vascular assessment when searching for causes of chronic abdominal pain in younger patients. The left renal vein is compressed between the aorta and superior mesenteric artery. With clinical signs (including left flank pain and macroscopic hematuria from rupture of small intrarenal veins), this can be termed nutcracker syndrome.

A similar but separate condition is when the acute angle formed between the aorta and the origin of the superior mesenteric artery compresses the third part of the duodenum causing early satiety, vomiting and abdominal pain. This rare gastrointestinal condition is known as SMA syndrome or Wilkie's syndrome. This and nutcracker syndrome can occur simultaneously, but are not exclusively found together. 

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