Girl with lower abdominal pain for years with "Nutcracker" syndrome rare in the population

On the afternoon of October 4, Ho Chi Minh City University of Medicine and Pharmacy Hospital announced that it had successfully performed surgery on a young girl suffering from a rare renal vein clamp syndrome that caused lower abdominal pain for many years, especially during her menstrual cycle.

The patient was thin and frail and came to the clinic because of pain in the left flank that spread to the lower abdomen for many years, greatly affecting his daily activities and quality of life. The patient had been examined and had abdominal ultrasounds at many different medical facilities for 3 years but the diagnosis was unclear and treatment was not effective.

The pain is usually dull and lasts for several days, increasing in intensity during the menstrual cycle. The patient has no previous medical history and has never had surgery.

Những cô gái mình dây, hay đau bụng dưới nên nghĩ đến bệnh hiếm gặp này - Ảnh 1.

Dr. Le Phi Long examines a girl after surgery

At the University of Medicine and Pharmacy Hospital, after a full examination of the gastroenterology, gynecology, etc. specialties to rule out common diseases that cause abdominal and lower abdominal pain, doctors performed a contrast CT scan of the abdomen to examine the organs and blood vessels of the abdomen. The CT scan image showed the left renal vein passing through a narrow gap and being clamped between the aorta and the intestinal artery, along with dilation of the left genital vein.

For further diagnosis to determine and examine the direction of blood flow, the patient underwent digital subtraction angiography.

On the angiogram, the blood flow from the kidney does not flow back to the systemic system because the vein is clamped and narrowed, resulting in blood flowing back like a waterfall into the genital vein, flowing back down to the lower abdomen, causing distension and blood stasis leading to pain.

Through specialized diagnostic means, the patient was diagnosed with Nutcracker syndrome (also known as nutcracker syndrome, due to the renal vein being clamped between two arteries in the abdomen).

After explaining carefully to the patient, the doctors chose the surgical option of re-inserting the gonadal vein into the left iliac vein to relieve pressure and divert the refluxed renal venous blood flow back to the host system, ending the stagnation of blood in the pelvis.

Surgery is performed through a small incision below the navel, through the retroperitoneal space, and making a vascular anastomosis.

After more than 2 hours, the doctors successfully redirected the blood flow through a vascular anastomosis. After 5 days of surgery, the patient recovered well, could sit up and walk by himself, and the pain was clearly relieved.

Dr. Le Phi Long - Deputy Head of the Thoracic - Vascular Department of the University of Medicine and Pharmacy Hospital, said that Nutcracker syndrome is a rare abnormality, caused by the phenomenon of blood vessels in the abdomen crossing and compressing each other, often occurring in thin people with thin abdomens. When veins pass through the narrow gaps created by the arteries, due to the thin nature of the vessel walls, these veins are easily crushed. In addition, the rhythmic pulsations of the neighboring arteries have an impact like a continuous punching machine on the vein wall, over time causing microscopic injuries to the vein wall and narrowing the lumen, leading to venous obstruction.

This syndrome is quite rare, the incidence rate in the population is currently unknown. In addition to causing unexplained pain, severe cases can affect the left kidney, causing blood in the urine, kidney failure...

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