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INTRODUCTION:
To our knowledge, this is the only reported case of nutcracker syndrome occurring in a left pelvic kidney. This resulted from compression of the left renal vein outflow by the overlying right common iliac artery. We treated this condition with a novel operation in which we transposed the left iliac vein anterior to the iliac artery.
METHODS:
We present a case of an 18 year old woman presented with left lower quadrant abdominal pain, worsening hematuria, and anemia. She was found to have a left pelvic kidney and subsequent cystoscopy demonstrated bloody urine from the left ureter. Subsequent MRA and venography showed compression of the left renal vein outflow by the right iliac artery with a significant gradient.
We performed a novel operation in which we transected the left iliac vein and reconstructed it anterior to the left iliac artery in order to relieve the point of compression.
RESULTS:
At six months follow up, the patient’s hematuria and left lower quadrant pain had resolved. Surveillance MRA of the bypass revealed a patent left iliac vein and renal vein with no signs of compression.
CONCLUSIONS:
This is a unique case of nutcracker syndrome occurring in a pelvic kidney. We used a novel surgical technique to reconstruct the iliac vein in a manner that relieved the obstruction. In medium-term follow up the reconstruction remains patent and the patient remains symptom-free.