Side pain, blood in urine due to rare 'nutcracker' syndrome

Mr. Nam had pain in his left flank, blood in his urine, and examination revealed varicocele due to the rare 'nutcracker' syndrome, with a rate of 3-4/100,000.

One day after surgery to treat congenital "nutcracker" syndrome, Mr. Ho Nam (21 years old, Tan Phu district, Ho Chi Minh City) no longer has flank pain, the veins on the testicles have disappeared. The patient received timely intervention to avoid complications of renal vein thrombosis, kidney damage, infertility...

Previously, Mr. Nam had a dull pain in the left flank, mixed with blood in his urine. Upon examination at Tam Anh Hospital, the doctor noticed prominent veins on the left testicle, diagnosing varicocele due to the patient suffering from "nutcracker" syndrome. Specifically, the renal vein was clamped by the aorta and superior mesenteric artery, preventing blood from flowing to the inferior vena cava. Gradually, blood stagnated in the left testicle, causing varicocele.

Dr. Nguyen Anh Dung, Head of the Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, said that patients with "nutcracker" syndrome need to have a stent placed or surgery to restore blood flow from the kidney to the heart. However, in this case, even though the narrowed blood vessel can be dilated, the stent can drift because the blood vessel will dilate over time. Therefore, the doctor decided to perform renal vein transfer surgery.

The doctor cut the compressed renal vein and attached it to the inferior vena cava, creating a new path for blood to flow from the kidney to the heart. Two days after the surgery, Mr. Nam's symptoms completely improved and he was discharged from the hospital.

Surgeons created a new path for blood from the kidney to the heart, releasing the compressed renal vein. Photo: Tam Anh Hospital — Surgeons created a new path for blood from the kidney to the heart, releasing the compressed renal vein. Photo: *Tam Anh Hospital*

Dr. Tran Quoc Hoai, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, explained that the two kidneys perform important functions in the body such as: removing waste from the blood, balancing body fluids, creating urine... Each kidney has a vein that carries blood from the kidney to the heart, called the renal vein. In nutcracker syndrome, the left renal vein is compressed and blood cannot circulate normally through this vein. Instead, blood flows back into other veins and causes them to swell. In some cases, blood stasis in the testicles causes varicocele, as in the case of patient Nam.

Nutcracker syndrome can occur at any age. Some studies show that the disease is more common in adolescents and young people aged 20-30. The disease cannot be prevented, but early detection and timely intervention will help prevent serious complications. "If you see symptoms of blood in the urine, pelvic pain, abdominal pain or pain on one side, pain during sex, dizziness when standing, prominent veins on the testicles... you need to see a doctor immediately," Dr. Hoai emphasized.

Thu Ha

*The names of the characters in the article have been changed.

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